Shields 2020 Employee Benefits Guide

Employee
Benefits Guide

2019

Employee Benefits Guide

2020

Table of Contents

Eligibility and Enrollment 2
Medical Insurance 3
Dental Insurance 9
Vision Insurance 10
Flexible Spending Account (FSA) 11
Health Savings Account (HSA) 12
Wellness Program 13
Weight Watchers 15
Group Life and Disability 16
Cigna Value Adds 18
Retirement Plan/ 401k 19
2020 Monthly MBTA Pass Form 21
Employee Assistance Program 22
Colonial Life Voluntary Benefits 23
Pet Insurance 24
Paid Time Off (PTO) 26
Holiday Policy 27
Additional Benefits 28
Shields Cares Mission 29
Required Notices 30

Eligibility and Enrollment

Shields is proud to offer employees a wide variety of benefits to meet their needs. Please take some time to review this
information to ensure you are getting the most out of your benefits. You may contact Human Resources with any questions
at: 617-376-7470 or [email protected].

Each benefit has its own eligibility criteria, which is typically based on scheduled hours. Specific criteria are included at the
beginning of each benefit section in the guide.

Eligible Dependents may include:
• Your legal spouse
• Your biological, adopted, step, or foster children who have not reached the age of 26
• Dependents 26 or more years old, primarily supported by you and incapable of self-sustaining employment by reason
of mental or physical handicap. Requires approval from underwriting.
• Your covered child’s child(ren), if your child dis under the age of 19 and you claim both as qualified tax-dependents

Changing Benefit Elections

As an employee who is eligible for benefits, you are allowed to make changes to your plan choices during the annual open
enrollment period. After the open enrollment period ends, you will not be allowed to make changes to your elections
unless you experience a qualifying event. Some qualifying events include:

• Change in marital status (marriage, death of spouse, divorce, legal separation)
• Change in number of dependents (birth, death, adoption, eligibility status, child support order)
• Change in employment status for you or your spouse (new employment, termination, leave of absence, full-time to

part-time or vice versa)
• Special enrollment rights under HIPAA
• Medicare coverage

If you have a qualifying event, you must notify Human Resources within 30 days of the change. Depending on the type of 2
event, you may need to provide proof of this change (for example: a marriage or birth certificate). If you do not notify
Human Resources within 30 days, you will have to wait until the next open enrollment period or a subsequent qualifying life
event to make benefit changes.

Medical Insurance

Blue Cross Blue Shield Offerings

As a Shields employee, you have access to comprehensive PPO medical coverage through Blue Cross Blue Shield. You
are eligible for medical coverage if you work 30 or more hours per week.

Shields offers three PPO plans through Blue Cross Blue Shield. Plan details are located on the next page. All plans are
considered high-deductible health plans under IRS guidelines. All medical services (with the exception of preventive
care) and pharmaceutical coverage are subject to the deductible before services are covered under BCBS. Subscribers
of a high-deductible health plan can prepare for deductible expenses by contributing to a Health Savings Account
(HSA); more information about HSAs can be found on page 8 of this guide.

A Preferred Provider Organization (PPO) plan works for you in two ways:

In-Network
Through a network of physicians and other service providers (such as hospitals and labs).

Out-of-Network
Through providers you select that are not in the network (out of network costs will be higher).

Each time you or a covered family member needs care, you choose whether to see an in-network or an out-of- network
provider.

When you use an in-network provider, also called "going in-network," you generally receive a higher level of benefits.
Also, fees from in-network providers tend to be lower, because the providers and BCBS have negotiated discounted
rates for services.

In-Network providers agree to accept the discounted rate and cannot balance bill (copays and/or deductibles may
apply).

You can visit the BCBS website at www.bcbsma.com to search for providers that are considered
in-network.
You can call (800) 262-2583 to speak with a customer services representative.
Member Advocacy: You can contact our benefits broker (NFP) or Human Resources:
Email: [email protected]
NFP Phone: (617) 405-1505
Shields HR: (617) 376-7470

3

Medical Insurance

PPO $1,500 PPO $2,000 PPO $2,500

Calendar Year Deductible

Individual $1,500 $2,000 $2,500

Family $3,000 $4,000 $5,000

Out-of-Pocket Maximum

Individual $5,950 $5,950 $5,950

Family $11,900 $11,900 $11,900

Employee Bi-Weekly Contributions

Employee $83.67 $62.38 $51.04

Employee + Child(ren) $214.50 $168.96 $146.35

Employee + Spouse $233.98 $184.28 $160.76

Family $297.90 $229.75 $194.58

All plans offer the same coverage, the difference is the deductible and your bi-weekly contribution.

Preventive Services In-Network Out-of-Network
Office Visits 100% coverage 80% coverage
Specialist Visits 100% coverage after deductible 80% coverage after deductible
Telehealth Visit 100% coverage after deductible 80% coverage after deductible
Routine Eye Exam 100% coverage after deductible 80% coverage after deductible
(1 visit every 12 months)
High-Tech Imaging 100% coverage 80% coverage
Labs & X-Ray
Emergency Room 100% coverage after deductible 80% coverage after deductible
Acupuncture 100% coverage after deductible 80% coverage after deductible
Outpatient Surgery 100% coverage after deductible 100% coverage after deductible
(Facility / All Others) 100% coverage after deductible 80% coverage after deductible
Inpatient Hospital 100% coverage after deductible 80% coverage after deductible
Prescription Drugs
Retail 100% coverage after deductible 80% coverage after deductible
Mail Order
$10 / $25 / $45 after deductible $20 / $50 / $90 after deductible
$20 / $50 / $90 after deductible Not covered

You can visit the BCBS website at www.bcbsma.com to search for providers that are considered in-network.

4

Medical Insurance- Pharmacy Benefits

Introducing Smart90®´

Convenience. Savings. Smart.

Getting 90-day supplies of certain maintenance medications saves you time and money.

With Smart90, you can get 90-day supplies of certain maintenance medications from a CVS Pharmacy™
location or by mail order when you order them through Express Scripts®´, an independent company
that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.
Maintenance medications, also known as long-term medications, are prescribed to treat chronic or
ongoing conditions, such as high blood pressure or diabetes. To view a list of medications that are
eligible for the Smart90 program, please visit myblue.bluecrossma.com/90daymeds.

Advantages of UsingSmart90 Where to Get Your
90-Day Prescriptions
Smart90 saves you time and money. You’ll pay
less for a 90-day supply than you would for three You have the choice to pick up your 90-day supply at any
30-day supplies of your maintenance medications. of the 9,800 CVS Pharmacy retail locations nationwide,
You’ll also be less likely to miss a dose since you or have it delivered to you when ordered through Express
won’t have to refill asoften. Scripts. Either way, you pay the same amount.

Smart90 Pharmacies Over 9,800

• Express Scripts CVS pharmacies
• CVS Pharmacy nationwide*

*Includes CVS within
a Target®’ location

Smart90 Savings Example*

Type of Prescription Tier 1 Medication Copay1 What You Pay Tier 3 Medication Copay
30-Day Prescription $15 Tier 2 Medication Copay2 $50
$30

90-Day Smart90 Prescription $30 $60 $150

*Example is for illustrative purposes only. Check your benefit materials for details about your pharmacy coverage 5
1,2Most maintenance medications fall under tiers 1 and 2 on a three-tier plan

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association

How to Fill Your Prescriptions with Smart90

Using Express Scripts Using a CVS Pharmacy

To place your order: Simply talk to your doctor or bring your prescription
to a CVS pharmacist and ask about getting a 90-day
1.Log in or register atexpress-scripts.com/90day, prescription.
or call Express Scripts at 1-800-892-5119
To find aCVS:
2.Express Scripts will contact your doctor to get
your 90-day prescription, and then deliver it 1. Go to CVS.com
right to your door
2. Click Store Locator
Orders are usually processed within 48 hours.
3. Search for a pharmacy near you
Delivery takes about eight days, or 10 to 14 days for
new prescriptions. You can check your order status
anytime by logging in to express-scripts.com and
clicking on Order Status.

How to Switch from Mail Order to a CVS Pharmacy

If you’re already receiving your 90-day prescriptions through mail order using Express Scripts,
but want to switch to CVS Pharmacy, go to your local CVS and tell the pharmacist. Remember
to cancel your auto-refills from Express Scripts.

Questions?
If you have questions, call Member Service at the number

on the front of your ID card.

Blue Cross Blue Shield of Massachusetts complies with ATENCIÓN: Si habla español, tiene a su disposición servicios
applicable federal civil rights laws and does not discriminate gratuitos de asistencia con el idioma. Llame al número de Servicio
on the basis of race, color, national origin, age, disability, sex, al Cliente que figura en su tarjeta de identificación (TTY: 711).
sexual orientation or genderidentity.
ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente
ATTENTION: If you don’t speak English, language assistance serviços de assistência de idiomas. Telefone para os Serviços aos
services, free of charge, are available to you. Call Member Membros, através do número no seu cartão ID (TTY: 711).
Services at the number on your ID Card (TTY: 711).

® Registered Marks of the Blue Cross and Blue Shield Association. ®´ Registered Marks, SM Service Marks, and TM Trademarks are the property of their respective owners. 6
© 2018 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.

188093M 55-1708 (12/18)

Getting Sick Isn’t
Convenient.

Well Connection Is.

You can see licensed doctors and providers for minor
medical and behavioral health care using live video visits
on your favorite device.

Real Doctors. Real Doctor Visits.

Licensed doctors and providers in the Well Connection network have
an average of 15 years of experience. They can look up your medical
history, diagnose and treat your symptoms, and prescribe medication,*
if necessary.

4.8 out of 5 How It Works

Doctor and provider 1. Download the Well Connection app,
rating from our members1 or visit wellconnection.com

2. Create an account and log in

3. Choose the type of service: medical
or behavioral

4. Pick an available provider

Benefits of Well Connection

Medical Behavioral Health Secure Low Cost
24/7 by Appointment and Confidential

Download the app or visitwellconnection.com. 7

*Some medications, such as controlled substances, cannot be prescribed online.
1. Source: American Well. AmWell TeleHealth Report, February 2018. Patient Satisfaction Survey Data, compiled December 2017-February 2018.

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.

Health Care for the Digital Age

You and your family members can visit doctors and providers anytime, anywhere in
the United States, at home, work, or on vacation, weekends and holidays included.
All you need is an internet connection and a smartphone, tablet, or computer with a
webcam.

Types of Covered Services

Urgent Care • Diarrhea • Pinkeye
• Gout • Hypertension
• Cold & flu • Strep throat • Migraines
• Bronchitis • Urinary tract infections • Pneumonia
• Sinus & respiratory infections
• Sore throat

Behavioral Health • Trauma • Couples therapy
• Child behavior • Stress
• Depression & anxiety • Bereavement • Divorce
• Sleep disorders
• Substance use disorder

Can I Have Live Video Visits with My Doctor?

If your local doctor is in the Blue Cross Blue Shield of Massachusetts network and offers covered services using
live video visits through another service other than Well Connection, you'll still be covered by your plan.* To find a local
doctor who offers live video visits, go to Find a Doctor & Estimate Costs at bluecrossma.com/findadoctor and select
Tech Savvy Office under Refine Your Results.

Find Out If You're Covered and What It Costs

Not all plans include coverage for live video visits. To find out if you're covered, or to see how much it costs,
call Member Service at the number on the front of your ID card.

*If your plan includes telehealth benefits.

Blue Cross Blue Shield of Massachusetts complies ATENCIÓN: Si habla español, tiene a su disposición
with applicable federal civil rights laws and does not servicios gratuitos de asistencia con el idioma. Llame al
discriminate on the basis of race, color, national origin, número de Servicio al Cliente que figura en su tarjeta
age, disability, sex, sexual orientation, or gender identity. de identificación (TTY: 711).

ATTENTION: If you don’t speak English, language ATENÇÃO: Se fala português, são-lhe disponibilizados
assistance services, free of charge, are available to you. gratuitamente serviços de assistência de idiomas.
Call Member Service at the number on your ID Card Telefone para os Serviços aos Membros, através do
(TTY: 711). número no seu cartão ID (TTY: 711).

® Registered Marks of the Blue Cross and Blue Shield Association. ®´, TM Registered Marks and Trademarks are the property of their respective owners. 8
© 2018 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.

181588M 55-1287 (04/18)

Dental Insurance

Good dental health is important to your overall well-being. Shields offers employees working 24 or more hours per
week comprehensive dental plans through Blue Cross Blue Shield.

Blue Cross Blue Shield

Calendar Year Deductible High Option Low Option
Individual
Family $50 $25
$150 $75

Calendar Year Maximum $1,000 $750
Diagnostic 100% coverage 100% coverage
Preventative Services 100% coverage 100% coverage
Restorative 80% coverage after deductible 75% coverage after deductible
Oral Surgery 80% coverage after deductible 75% coverage after deductible
Periodontics:
80% coverage after deductible 75% coverage after deductible
Periodontal Surgery
(One surgical procedure per quadrant 80% coverage after deductible 75% coverage after deductible
in 36 months)
Scaling and Root Planning 80% coverage after deductible 75% coverage after deductible
(Once in 24 months, per quadrant)
Periodontal Cleaning 80% coverage after deductible 75% coverage after deductible
(Once every 3 months following 80% coverage after deductible 75% coverage after deductible
active periodontal treatment. Not to 80% coverage after deductible 75% coverage after deductible
be combined 50% coverage after deductible
with preventive cleanings) 50% coverage after deductible Not covered
Endodontics
Prosthetic Maintenance Covered at 50% of Maximum Plan 90th Percentile
Emergency Dental Care Allowance charges up to age 19. $1,000 Full-Time
Prosthodontics $9.02
Major Restorative separate LIFETIME maximum $20.29
$18.04
Orthodontics 90th Percentile $29.30
Full-Time Part-Time
Usual & Customary Charges $14.25 $10.09
Employee Bi-Weekly Contributions $32.09 $22.73
Employee $28.52 $20.21
Employee + Child(ren) $46.34 $32.84
Employee + Spouse Part-Time
Family $16.86
Employee Bi-Weekly Contributions $37.97
Employee $33.75
Employee + Child(ren) $54.83
Employee + Spouse
Family

You can visit the BCBS website at www.bcbsma.com to search for a dentist and much more. 9

Vision Insurance

Medical plans offered through Blue Cross Blue Shield provide a basic vision benefit; a more comprehensive plan is
available through EyeMed. The EyeMed plan is offered to employees working 24 or more hours a week. The plan helps
you pay for a wide range of vision-related services and products as shown below.

Exam (1 every 12 months) EyeMed Vision Out-of-Network Doctors
In-Network Doctors Reimbursed up to $50

$20 copay

Lenses (1 every 12 months) $20 copay Reimbursed up to $130
(Special lens types may have additional cost)
Frames (1 every 12 months)
Up to $130 retail allowance then 20% discount Reimbursed up to $104
Contact Lenses on balance
(1 every 12 months)
Elective: Up to $130 allowance then 15% Elective: Reimbursed up to $130
Discounted Laser Vision discount on balance
Correction Surgery Medically Necessary: Reimbursed up
Employee Bi-Weekly (fitting and evaluation covered separately at a to $210
Contributions $40 copay for standard lens fitting)
Employee
Employee + 1 Medically Necessary: Covered at 100%
Family
Average 15% discount or 5% off promotional price
Discounts only available from contracted facilities

$2.83
$5.39
$7.91

You can visit the EyeMed website at www.EyeMed.com to search for an EyeMed Doctor, file a claim reimbursement,
and much more.

10

Flexible Spending Account (FSA)

Shields offers Medical and Dependent Care Flexible Spending Accounts (FSAs), administered by HRC Total Solutions,
which allows you to pay for eligible health and dependent care expenses with pretax dollars. The FSA benefit is
available to employees working 24 hours or more per week.

If you are enrolled in the Health Savings Account (HSA) you are NOT eligible for the FSA medical care account.

Please note that FSA elections must be made each year and run from January 1 to December 31. The last day an
employee can incur claims is December 31st. Employees have until March 31st of the next year to submit claims for
reimbursement from prior year.

Medical Care Flexible Spending Account

The Medical Care Flexible Spending Account can be used for all medically necessary physician prescribed expenses not
covered by insurance and are eligible under Section 213 of the IRS. You may elect to defer from $100 to $2,650 of your
salary into a health care FSA. The $2,650 limit applies individually.

HRC Total Solutions provides a Visa iCard that you can use to pay for eligible expenses. Current FSA card holders will
continue using the existing card. If you prefer, you can submit a claim on-line or mail in a claim directly to HRC Total
Solutions. Log into HRC Total Solutions and see all of your election, plan activity and balance(s).

Some of the eligible expenses for the Medical Care Flexible Spending Account include:

Insurance deductibles, co-insurance and co-payments Hearing exams and hearing aids
for medical, dental and vision
Eye exams, eyeglasses, contact lenses
Dental expenses not covered or not paid in full by insurance and necessary supplies

Acupuncture Chiropractic treatment

Dependent Care FSAs

Dependent Care Accounts can be used for the cost of caring for eligible dependents while you work. You may elect to
defer from $100 to $5,000 of your salary into a dependent care FSA. Keep in mind that this is a per household limit. If
you are a highly compensated employee (HCE), defined by the IRS as an employee with annual compensation greater
than $115,000, your election will be capped at $2,500 and may be reduced during the year, if necessary, to ensure that
the plan passes required discrimination testing.

Some of the eligible expenses for Dependent Care Reimbursement include:

After School Care Nursery School Summer Day Camp Pre-School
Child Care Expenses
Elder Care Caregivers for a disabled spouse or dependent who lives
in your home

Medical and/or dependent FSA prohibits cancellation of coverage during the year unless you experience a qualifying
event as defined by the IRS.

11

Health Savings Account (HSA)

A Health Savings Account (HSA) offered by Fidelity allows members to put money aside to pay for current and future
qualified medical expenses using pre-tax dollars. An HSA allows dollars to “roll over” annually. Your HSA provides a
triple tax advantage; contributions are tax deductible, balances grow tax free, and all withdrawals for qualified
expenses are tax free.

Eligibility Requirements
• Must be enrolled in a High Deductible Health Plan
• Must not be enrolled in Medicare
• Must not be covered by other medical insurance(s)
• Must not have received VA medical benefits at any time in the past three months
• Spouse not contributing to/participating in a general-purpose FSA through his/her employer

Maximum tax-deductible contribution to an HSA for 2020

• $3,550 for an individual medical insurance plan

• $7,100 for employee + spouse, employee + child(ren) and family medical insurance plan

• Catch up provision for anyone over the age of 55 is $1,000

Some of the eligible expenses for Medical Care Reimbursement include:

Insurance deductibles, co-insurance and co-payments for medical, Hearing exams and hearing aids
dental and vision

Dental expenses not covered or not paid in full by insurance Eye exams, eyeglasses, contact lenses and necessary
supplies

Acupuncture Chiropractic treatment

*Please note that maximum contributions for HSA’s are based on employee and employer contributions.

Debit Card

An HSA debit card will be provided to all participants. Your HSA card can be used to pay for qualified medical expenses billed from
an insurance company, a physician’s office and a pharmacy.

Shields Contributes To Your HSA – Wellness Program
For 2020, employees are eligible for contributions awarded by completing wellness initiatives. Total available amounts
below:

• Full-Time (4o hours per week) Individual: $250.00
• Full-Time (40 hours per week) Employee + spouse, employee + child(ren)& Family: $500.00
• Part-Time: one-time $100.00 employer contribution upon initial enrollment

12

Wellness Program

The Shields Wellness Program is designed to support healthy behaviors and improve health outcomes.
Shields rewards certain activities through HSA employer contributions for those enrolled on the Blue Cross
Blue Shield Health Plan and HSA. To receive the full employer contribution, employees will need to achieve
100 points, which will be tracked in ahealthyme (the Blue Cross Blue Shield wellness portal).

Coverage Maximum Employer Points Required to Receive Points Required to Receive
Contribution Full Contribution 50% Contribution
Full-time Individual $250 100 points 50 points
Full-time Employee + Spouse,
Employee + Child(ren) or Family $500 100 points 50 points

Step 1 – Be Preventive! Points Earned When Will Points Be Total Points
Available Possible

Personal Health Assessment 15 Upon completion 15

Annual Physical Nutrition 25 1-3 months after 25
Annual Dental Exam 15 completion
Step 2 – Choose Your Wellness Focus: 15
Physical Activity 1-3 months after Total Points
completion
Possible
Stress Management

Choose different activities to complete based on the areas of wellness that are most important to you!

Attend 1 WW class in a month   50
10pts/month

Track what you eat on the food log  50
5pts/day

Track 10,000 steps/day   50

4pts/day

Participate in a charitable 5k (max:2)   20
10pts/race

Finding the Right Balance Workshop   25
25 pts

Fit for Life Workshop  25

25 pts

Smart Choices Workshop  25

25 pts

Take a Break Workshop  25

25 pts

Mindful Living Workshop  25

25 pts

Wellness Coaching    50

50 pts

Remember… 13
• 50% of eligible HSA contributions will be provided when you reach 50 points
• The remaining 50% will be provided when you achieve an additional 50 points, for a total of 100 points
Did you know?
• Spouses and dependents (18+) on the Shields medical plan, AND employees not on the Shields medical plan have access to

the ahealthyme portal too! Though they are not eligible for any incentives, your family can still engage in their health and
take advantage of the cool resources available through ahealthyme.

Wellness Program

To register for ahealthy me visit www.ahealthyme.com/login
• Shields medical plan members: input your 11-digit member ID (9-digit BCBSMA ID + 2-digit suffix) and

DOB
• Non-members, spouses, and dependents (18+): input your 11 digit personal access code and DOB
Once your information is entered, accept the Terms of Use and Privacy Policy, then click ‘submit’. You will be
brought to your ahealthyme homepage.

Program Activity How to earn points

Personal Health Assessment Log on to ahealthyme to complete the Health Assessment.

Annual Physical Shields medical plan members: your Well-Visit will automatically appear
(allow for up to 90 days for points to appear on ahealthyme).
Annual Dental Exam
Attend 1 WW class in a month Non-members, spouses, dependents (18+): complete the Preventive Well-Visit
Track what you eat on the food log Attestation on ahealthyme
Track 10,000 steps/day
Participate in a charitable Shields dental plan members: your Dental Exam will automatically appear
race/walk (allow for up to 90 days for points to appear on ahealthyme).

Workshop completion Non-members, spouses, dependents (18+): complete the Dental Exam Attestation
on ahealthyme
Wellness coaching
Please provide proof of class attendance to Jennifer Burt
([email protected]).

You will see credit for these activities at the beginning of the next month.

Log on to the ahealthyme, the Food Log can be found under the “Nutrition” tab.
Points accrue immediately after appropriate tracking.

Log on to the ahealthyme secure site homepage, the Steps Log is located under
the

“Exercise” tab. Points will be automatically awarded to your ahealthyme account.
To receive points for a charitable race/walk, please provide proof of participation

(e.g. photo of bib number) to Jennifer Burt ([email protected]).
You will see credit for these activities at the beginning of the next month.
Log on to ahealthyme, go to Wellness Workshops in the top navigation bar, and

select “Sign Up for a Workshop” from the drop-down list.
Please note, points will not be earned for the Flu or Advance Care Planning

workshop, unless otherwise indicated.
Points will be awarded upon completion of the last task of the multi-week

workshops.
Individuals can either call or receive a call from a Coach to get support in making

healthy lifestyle changes. Points will display on ahealthyme on the 15th of the
following month after the goal has been met with your coach

14

Shields Health Care Group employees* can participate in WW Local Workshop
Voucher program with no registration fee and a discounted rate of $106 per

14-week program- a savings of over $50!

To purchase a voucher, contact Human Resources at: [email protected] 15

To learn more about WW, visit wellness.weightwatchers.com

*Employees must have regularly scheduled hours to participate.
*Vouchers should be valued the same as cash. They cannot be replaced if lost or stolen. Use of these vouchers may not be
combined with any other offer and they cannot be transferred. These vouchers may be used only in participating areas in the
U.S. Prepayment of vouchers required.
The WW Coin Logo and Weight Watchers are the registered trademarks of WW International, Inc. WW Freestyle is the
trademark of WW International, Inc.
©2018 WW International, Inc. All rights reserved.

Group Life and Accidental Death
and Dismemberment (AD&D)

Shields offers Basic Life and AD&D insurance through Cigna. This benefit is offered at no cost to eligible employees
working 32 or more hours per week.

Eligibility Life and AD&D
Schedule of Benefits
Age Reduction Schedule All full-time active employees regularly working at least 32 hours per week
Guarantee Issue 1 times your annual salary, to a maximum of $50,000
Waiver of Premium 35% at age 70
Conversion Privilege $50,000
Portability Included
Accelerated Benefit Included
Contributions Included
Included
100% Employer Paid

Voluntary Life and Accidental Death and Dismemberment (AD&D)

Shields offers the option to purchase additional Life and AD&D Insurance for you and your dependents. This coverage is
in addition to the Company paid Basic Life and AD&D Insurance. The cost of this coverage is employee paid. Coverage
amounts over the guarantee issue will require approval from the carrier through Evidence of Insurability.

Supplemental Life and AD&D

Eligibility All active employees regularly working at least 32 hours per week
Employee Benefit
Spouse Benefit 1-7x Annual Earnings in increments of $10,000 to a maximum of $500,000
Dependent
(age 6 months to 25 years) $5,000 increments up to lesser of 100% of the employee life amount or $100,000

Guarantee Issue Birth to age 6 months: $1,000

Age Reduction 6 months to age 26: $1,000 increments up to $10,000

Age Employee - $200,000

< 30 Spouse - $30,000
30 - 34
35 - 39 Dependent - $10,000
40 - 44
45 - 49 Employee: 35% at age 70; Spouse: coverage terminates at age 70
50 - 54
55 - 59 Monthly Rate Information per $1,000
60 - 64
65 - 69 Employee Spouse Dependent
70 - 74
75+ $0.070 $0.070 $0.04

$0.090 $0.090 -

$0.110 $0.100 -

$0.160 $0.140 -

$0.240 $0.220 -

$0.390 $0.370 -

$0.600 $0.580 -

$0.790 $0.770 -

$1.280 $1.280 -

$2.230 - -

$2.231 - -

Note: AD&D coverage available for employees and spouses only. 16

Group Disability

Shields provides Short Term Disability and Long Term Disability coverage at no cost to you. Enrollment is
automatic for all eligible active employees working at least 32 hours per week.

Short Term Disability (STD)

Short Term Disability Insurance provides you with income continuation in the event you become disabled due to
an illness, pregnancy or non-work related accident. Benefits will begin after 7 days of disability.

Eligibility Short Term Disability
Schedule of Weekly Benefits All full-time active employees regularly working at least 32 hours per week
Maximum Weekly Benefit
Benefits Begin 60%
Accident $500
Sickness
Maximum Benefit Duration 8th
Contributions 8th
12 weeks
100% Employer Paid

• Benefits received may be taxable
• Physicians are not eligible for Short Term Disability

Long Term Disability (LTD)
Long Term Disability Insurance provides you with income continuation in the event you become totally disabled. Benefits
begin after a 90 day elimination period.

Eligibility Long Term Disability
Schedule of Monthly Benefits
Maximum Monthly Benefit All full-time active employees regularly working at least 32 hours per week
Elimination Period 60%

Benefit Duration $10,000
90 days
Contributions Benefits are paid for 24 months if you are disabled from your own occupation or to age 65 if
deemed totally disabled
100% Employer Paid

• Benefits received may be taxable
• Cigna LTD provides the following:

• No limitation on attempted trial work days
• 24 month Return to Work incentive
• Unlimited workplace accommodation dollars and a free ADA helpline
• Unlimited Rehabilitation dollars to employees participating in the Cigna rehabilitation program

17

Cigna Value Adds

Cigna offers the following value added services for those enrolled in Cigna coverage:

Healthy Rewards

Reward yourself! You and your family members can enjoy instant savings using Cigna’s Healthy Rewards®*
program which can help with discounts on a wide variety of health and wellness programs and services.

• To find out more about Healthy Rewards or for a list of participating providers, call 1.800.258.3312 or visit
www.Cigna.com/rewards Password: savings

Identity Theft Program

Identity Theft occurs when someone uses your personal identifying information, like your name, Social Security
number, or credit card number, without your permission, to commit fraud or other crimes. It’s America’s fastest
growing crime, victimizing about 12.7 million people in 2014. Cigna’s Identity Theft program is available to help if
this serious crime impacts you.

• If you suspect you might be a victim of identity theft, call 1.888.226.4567 (U.S. and Canada) or 202.331.7635.
Personal case managers are standing by to help you. Please indicate that you are a member of the Cigna
Identity Theft Program and group #57.

Will Preparation

Sixty-four percent of Americans do not have a will. That means that they have little or no control over decisions
after they die. It also leaves a burden on family members. They must make hard choices at an emotional time.
Advance planning helps to make the process easier. And Cigna’s Will Center can help you with the planning
process.

• Visit www.CignaWillCenter.com to get started. For help, you can call 1.800.901.7534 or send an email help
request to [email protected].

Secure Travel Program

Cigna Secure Travel® customer service is available 24 hours a day, 365 days a year wherever you are in the world.
In an emergency, you can even call collect. All of the program services are available when you travel over 100
miles from home (see your plan for details).

Contact Information: Policy Information:
• US & Canada: 1.888.226.4567 • Name: Shields Health Care Group
• From Other Locations: 1.202.331.7635 • Policy #: OK969573
• By Fax: 202.331.1528 • Group #57
• By Email: [email protected]
18

Retirement Plan

Shields offers an employer sponsored 401(k) retirement plan through Fidelity. Employees can enroll in the plan if
they’re 21 years of age and worked 1 hour within in the initial 30 days of employment. Employees will be auto-enrolled
in the traditional 401(k), at a contribution rate of 3%, the month following 30 days of employment.

Contribution Amount: You can contribute between 1%-75%, up to $19,500 of your pay on a pre-tax and/or Roth
deferral.

Catch-Up Contributions: Allowed if you are at least age 50 or will attain age 50 before the end of the calendar year,
the contribution allowed is $6,500. Catch-up contributions for those eligible will automatically be taken once annual IRS
maximums are reached, unless you change your deferral elections with Fidelity.

Automatic Deferral: If you don’t enroll or defer in the plan when eligible, you will be automatically enrolled at 3%. You
can opt out at any time.

Automatic Escalation: July 1st of every year you contribution will automatically increase by the schedule below:

Plan Year Automatic Deferral Percentage
1st 4%
2nd 5%
3rd 6%
4th 7%
5th 8%
6th 9%
7th 10%
8th 11%

Investments: The plan offers many investments to choose from. Please consult the enrollment booklet or contact
Human Resources for more information.
Employer Match: Shields may make a discretionary contribution to the plan each year. Employees must be employed
by Shields on December 31st in order to be eligible for the employer match
Vesting Schedule: The employer match follows the vesting schedule below:

Period of Service Percentage
Less than 1 0%
1 20%
2 40%
3 60%
4 80%
5
100%

19

Retirement Plan, cont’d

Please take time to register on NetBenefits.com. With NetBenefits.com, you will have access to account balances,
investments, educational resources and more.

If you have previously registered on Fidelity.com, NetBenefits or eWorkplace, you do not need to register again. Use
your existing user name and password to access your new account. If you have not yet registered, go to
NetBenfits.com and click Register as a new user. Follow the instructions to set your unique username and password. If
you need help setting up your account, call 1-800-603-4015.

For mobile access, download the NetBenefits app by clicking the links below.

Or you can scan this QR code on your
mobile device to download the app.

20

2020 Monthly MBTA Pass Form

You will need to complete the form below if you would like to START, STOP, or CHANGE a monthly MBTA pass via payroll
deduction. The form can be found on the Shields InfoHub.

Shields Health Care Group MBTA Pass policy:

• This must be used as your primary transportation to and from work.
• You must be an active Shields’ employee, regularly scheduled for 20+ hours per week.
• The cost of the pass is deducted for the month PRIOR to the pass month.
• A Charlie Card (Subway/Bus Pass) is replenished every month as long as you are eligible.
• Employees may not submit for parking reimbursement if enrolled in the T Pass Program.
• Employees not using the MBTA benefit may submit for on-site parking expenses, with a maximum reimbursement of $9.50 per

shift/ day worked.

What would you like to do? Start Stop Change Pass: From to

Select Month (Required Field) Your Cost
$30.00
Pass Type Original Cost $49.00
LOCAL BUS $55.00 $75.00
SUBWAY + BUS (LINK) $90.00 $70.30
ZONE 1A $90.00 $100.50
INNER EXPRESS BUS $136.00 $139.00
OUTER EXPRESS BUS $168.00 $156.00
$214.00 $184.00
ZONE 1 $232.00 $201.50
ZONE 2 $261.00 $226.00
ZONE 3 $281.00 $253.00
ZONE 4 $311.00 $271.00
ZONE 5 $340.00 $296.00
ZONE 6 $360.00 $314.00
ZONE 7 $388.00 $338.00
ZONE 8 $406.00 $245.00
ZONE 9 $426.00
ZONE 10 $329.00
BOAT

Print Name Signature Ext. Date:

PLEASE NOTE: Due to the nature of the T-Pass deduction we are unable to process request forms after the 15th of each month. 21
This form is subject to approval based on Tufts and MBTA Policy.

Email: [email protected]
HUMAN RESOURCES
Phone: 617-376-7470

Fax: 617-376-7471

Employee Assistance Program

Shields Health Care’s Employee Assistance Program (EAP), provided by KGA, is a free, confidential benefit for all
Shields Health Care employees and their adult household members designed to help with the pressures of
everyday life.

At no cost to you, the EAP provides an opportunity to talk with counselors about personal concerns such as
stress, anxiety, depression, couples’ issues and substance use or abuse.

The EAP also offers free confidential telephone consultation and referral services for career issues, child care,
elder care, legal and financial concerns.

The EAP can help you with situations like…

• A landlord/tenant dispute

• Falling behind on your New Year’s resolutions

• Finding a summer camp or day care for your kids

• Looking for a place to live

• Planning for aging parents

• Investing questions you may be confused about

• Expecting a baby

• Solving relationship troubles

• And so much more!

As a part of Shields Health Care’s EAP, KGA also has a variety of health and
wellness information and tools available to help with the challenges in your family’s
health. Visit the KGA website (https://my.kgalifeservices.com/o/shields) to learn more about all of the
services KGA offers.

Note: All services provided by KGA are strictly confidential. Counselors are
available 24/7 to
help with your

needs and
questions!

22

Colonial Life Voluntary Benefits

Shields is pleased to offer voluntary benefits through Colonial Life. You are encouraged to speak with a benefits
counselor. The counselor will answer any questions you may have and offer you simple, straightforward advice as you
sort through your choices.

The following voluntary benefits will be offered during the enrollment:

Short Term Disability Insurance helps you pay everyday living expenses and out-of-pocket expenses not covered by
major medical plans. Provides a monthly benefit to replace your income if you are unable to work due to a covered
disability. Choose among a variety of plans.

Accident Insurance helps offset unexpected medical expenses, such as deductibles and co-payments that can result
from a fracture, dislocation or other covered accidental injury.

Critical Illness Insurance helps offset the out-of-pocket medical and indirect non-medical expenses related to critical
illness that most major medical plans may not cover.

Whole Life Insurance provides death benefit coverage with guaranteed features including cash value accumulation,
premium rates and death benefit (minus any loans and loan interest). Flexible premium payments and coverage
amounts.

Complimentary benefits provided to you when you meet with a benefit counselor!

COMPLIMENTARY College Tuition Benefit Provides guaranteed college scholarships, designed to benefit your children,
grandchildren, nieces and nephews. Each child you enroll can earn up to 1 free year of college tuition at over 350+
colleges across the US. See the list of schools at www.collegetuitionbenefit.com.

COMPLIMENTARY WellCard - Provides discounts on health and wellness services. It could save you money on doctor
office visits, prescription drugs and more. Visit www.WellCardSavings.com for more information.

COMPLIMENTARY KOFE Financial Resources and Counseling - This new program provides tools and resources,
including access to your own personal financial advisor, to help you achieve optimal financial wellbeing. Get hands on
support on topics like budgeting, savings, debt management and consolidation, retirement planning, investing, and
more!

Important features of Colonial Life’s coverage:
• Benefits are paid directly to you, unless you specify otherwise, to use as you see fit.
• With most plans, you can continue coverage with no increase in premium when you retire or change jobs.
• Most plans pay benefits regardless of any other insurance you may have with other companies.
• Most plans offer coverage for your spouse and dependent children.

To enroll or obtain more information, please contact Colonial directly at 888-623-6236 x 808.

23

Pet Insurance

As a Shields employee, you are eligible to enroll in Voluntary Pet Insurance through Nationwide – the #1 choice in
America for pet insurance. Nationwide offers simple pricing, no age restrictions and no lifetime limits!
The My Pet Protection with Wellness and My Pet Protection plans reimburse a straightforward 90% of your vet bill
instead of using an actual benefit schedule. A $250 annual deductible and $7,500 maximum annual benefit apply to
both plans.

• Accidents, including poisonings and allergic reactions Just like all other pet insurers, we don’t cover
• Injuries, including cuts, sprains and broken bones pre-existing conditions*. However, we go
• Common illnesses, including ear infections, vomiting above and beyond with extra features such as
emergency boarding, lost pet advertising and
and diarrhea more. This plan has a low $250 annual
• Serious/chronic illnesses, including cancer and diabetes deductible and a generous $7,500 maximum
• Hereditary and congenital conditions annual benefit.
• Surgeries and hospitalization
• X-rays, MRIs and CT scans
• Prescription medications and therapeutic diets

*Any illness or injury that your pet had prior to the start of your policy will be considered a pre-existing condition.
Preventive care coverage is available for checkups, shots and more through My Pet Protection with Wellness®.

24

Pet Insurance
How to Enroll

Nationwide provides coverage for veterinary expenses related to accidents and illnesses. Policies are available for
dogs, cats, birds, reptiles and other exotic pets.

Optional wellness coverage is also available for dogs and cats, providing reimbursement for the preventive care
necessary to keep them healthy year after year.

Eeansryollment 1 Select the species 2 Provide your 3 Pick your
(dog or cat)* zip code plan

*To enroll your bird, rabbit, reptile or other exotic pet, please call 888-899-4874.

My Pet Protection® is available exclusively through your employer.
Enroll online today—it’s quick and convenient. www.petinsurance.com/shields or 877-738-7874

During enrollment, you may be asked for the following information:
• Home or primary telephone number
• Name
• Address
• E-mail address
• Name of your pet
• Pet’s species (canine, feline, etc.)
• Pet’s date of birth
• Pet’s sex
• Pet’s breed
• Pet’s color
• Medical questions about pet’s current and past health, medications and date of last veterinary visit
• Preferred animal hospital (note: you’re free to use any veterinarian)
• Payment information/plan

* If payroll plan is available to you: applications approved between the 1st and the 15th of the month become effective
on the 1st of the following month. Applications approved from the 16th through the end of the month become
effective on the 1st of not the following month, but the month thereafter.

Example:
May 1 approval = June 1 effective date
May 16 approval = July 1 effective date

25

Paid Time Off (PTO)

Shields Health Care Group recognizes that a healthy work/life balance is important to your well-being. That is why you
are provided with Paid Time-Off (PTO) for personal, leisure, and wellness time management. You may use your PTO for
purposes such as vacations, sick time, and personal days.

Service Years/Scheduled Weekly Hours PTO Accrual Annual Hour
Weekly Accrual Hours

0 to 2 years/ scheduled FT 40 hours 2.92 152
0 to 2 years/scheduled PT 32-39 hours 2.35 122
0 to 2 years/scheduled PT 24-31 hours 1.77 92
0 to 2 years/scheduled PT 20-23 hours 1.47 76
2+ to 5 years/ scheduled FT 40 hours 3.70 192
2+ to 5 years/scheduled PT 32-39 hours 2.97 154
2+ to 5 years/scheduled PT 24-31 hours 2.23 116
2+ to 5 years/scheduled PT 20-23 hours 1.85 96
5+ years/scheduled FT 40 hours 4.47 232
5+ years/ scheduled PT 32-39 hours 3.58 186
5+ years/scheduled PT24-31 hours 2.70 140
5+ years/ scheduled PT 20-23 hours 2.23 116

*For those working under 20 hours per week, please see the Employee Handbook for the Shields Sick Time Policy.

26

Holiday Policy

Holidays Policy

Employees regularly scheduled to work at least 20 hours per week will receive holiday pay for the eight days listed
below. The amount of time paid for the holiday is pro-rated for any employee who is regularly scheduled to work 20
hours or more, but less than 40 hours per week. The following describes the hours paid for eligible employees:

Regular Schedule Per Week Paid Holiday
40 hours 8 hours
6.5 hours
32 – 39 hours 5 hours
24 – 31 hours 4 hours
20 – 23 hours

• New Year's Day - January 1 • Labor Day - 1st Monday in September
• Washington's Birthday - 3rd Monday in February • Thanksgiving—4th Thursday of November
• Memorial Day - Last Monday in May • Christmas Day - December 25
• Independence Day - July 4 • Float Holiday

The Company will generally be closed on New Year’s, Thanksgiving, and Christmas days. However, some locations may
be open due to the needs of the partnering hospital. SHC will open centers on the other holidays based on patient
referrals. If referrals are low, the decision to close any/all centers will be made at least 72 hours in advance.

Information about any holiday listed above that falls on a Saturday or Sunday will be communicated in the first quarter
of each calendar year.

Hourly employees who work on a designated Company holiday will be paid time and one-half for any hours worked,
and eligible holiday pay. Hourly employees who work after 4pm on Christmas Eve and New Years Eve will be paid time
and one-half for all hours worked.

27

Additional Benefits

For detailed information on benefits listed below, please refer to the HR Topics / Forms page of the SHCWEB or contact
Human Resources.

Shields University
Employee of the Year Awards
You Make the Difference Recognition Program
WOW Co-Worker Recognition Program
Bank at Work Programs – banking from exclusive banking benefits & services
Free Annual Employee Flu-shot Clinics
Employee Perks – vendor discounts & more!

Free Parking at all Centers
Tuition Assistance

28

Shields Cares Mission

Shields Cares is an employee innovated and managed fund-raising group. The objective of this group is to grow a pool
of funds that will be used to assist our co-workers who have financial needs based on unexpected medical needs. This
grass-roots initiative is based on the Shields core values of kindness, character and excellence.
Shields Cares contributions are made via payroll deduction. Please see ADP for contribution information.

Shields Cares Initiative
Hat, Mitten and Glove Drive

Blood Drive
Bell of the Ball
Relay for Life
Cell Phones for Soldiers
Supplies for Soldiers

Coat Drive
Adopt-A-Family Holiday program

SHCG School Backpack Drive
New Bedford Salvation Army Food Drive

Halloween Costume Drive

29

Required Notices and Employment Information

As an employee, the benefits available to you represent a significant component of your compensation package. They
also provide important protection for you and your family in the case of illness or injury.
The following documents that contain summary information about your benefits may be accessed from our intranet
under “Mandatory Benefit Notices” under the Human Resources section:

• Summary Plan Descriptions
• Summary Annual Report
• Certificates of Coverage
• Summary of Benefits and Coverage (SBC)
• Massachusetts Family and Medical Leave Act Notice
• Medicare Part D Notice
• Annual Wellness Notice
You can access these notices on the Shields InfoHub. They can be found under Pay & Benefits, 2020 Benefits
Information.
The Employee Handbook can be found on the Shields InfoHub under Policies and Procedures.

30

Employer Notice to Employee

Rights and Obligations under the Massachusetts Family and Medical Leave Law, M.G.L. c. 175M

Shields Health Care Group

(Employer Name)
700 Congress Street, Suite 204

(Employer Street Address)

Quincy, MA 02169

(Employer City, State, Zip)

04-3164965

(Federal Employer ID Number)

Explanation of Benefits

• Beginning January 1, 2021, you may be entitled to up to
o 12 weeks of paid family leave in a benefit year for the birth, adoption, or foster care
placement of a child, or because of a qualifying exigency arising out of the fact that a
family member is on active duty or has been notified of an impending call to active
duty in the Armed Forces;
o 20 weeks of paid medical leave in a benefit year if they have a serious health condition
that incapacitates them from work
o 26 weeks of paid family leave in a benefit year to care for a family member who is a
covered service member undergoing medical treatment or otherwise addressing
consequences of a serious health condition relating to the family member’s military
service.

• Beginning July 1, 2021, you may be entitled to up to
o 12 weeks of paid family leave in a benefit year to care for a family member with a
serious health condition.
o 26 total weeks, in the aggregate, of paid family and medical leave in a single benefit
year.

Your weekly benefit amount will be based on the employee’s earnings, with a maximum benefit
of $850 per week.

31

Job Protection, Continuation of Health Insurance, No Retaliation

• Job Protection: Generally, if you take family or medical leave under the law you must be restored to your previous
position or to an equivalent position, with the same status, pay, employment benefits, length-of-service credit and
seniority as of the date of leave.

• Continuation of Health Insurance: Your employer must continue to provide for and contribute to your
employment-related health insurance benefits, if any, at the level and under the conditions coverage would have
been provided if you had continued working continuously for the duration of such leave.

• No Retaliation: It is unlawful for any employer to discriminate or retaliate against you for exercising any right to
which you’re entitled under the paid family and medical leave law. An employee or former employee who is
discriminated or retaliated against for exercising rights under the law may, not more than three years after the
violation occurs, institute a civil action in the superior court.

Contributions to the DFML Family and Employment Security Trust Fund

On October 1, 2019, contributions to the Department of Family and Medical Leave (DFML) Employment Security Trust
Fund will begin. An employer will be responsible for sending contributions to the DFML for all employees, though they
may deduct a portion from employee pay. The contribution rate may be adjusted annually and can be found in the
attached effective rate notice.

How to File a Claim

• Employees must file claims for paid family and medical leave benefits with the DFML using the Department’s forms.
Forms and claim instructions will be available on the Department’s website www.mass.gov/DFML before January
2021.

• Employees are required to provide at least 30 days’ notice to their employer of the anticipated starting date of any
leave, the anticipated length of the leave and the expected date of return. An employee who is unable to provide 30
days’ notice due to circumstances beyond his or her control is required to provide notice as soon as practicable.

Payment for Concurrent Leave

Any paid leave provided under a collective bargaining agreement or employer policy and paid at the same or higher
rate than paid leave available under this law shall count against the allotment of leave benefits available under this
law.

Private Plan Exemption

An employer that offers paid leave with benefits that are at least as generous as those provided under the law may
apply for an exemption from paying the Department of Family and Medical Leave Family and Employment Security
Trust Fund contribution. An employer may apply for an exemption from the medical leave contribution, family leave
contribution, or both.

The details of any private plan must be provided to employees by an employer at the same time as this Notice.

Employees enjoy rights to job-protected leave and from discrimination and retaliation under the law even if their
employer is approved to provide leave benefits through a private plan.

32

Shields Health Care Group X Does not have an approved private plan;
(Employer Name)
Has an approved private plan for both family and

medical leave;

Has an approved private plan for family leave only;

Has an approved private plan for medical leave only.

Department of Family and Medical Leave (DFML) Contact Information
The Massachusetts Department of Family and Medical Leave

Charles F. Hurley Building
19 Staniford Street, 1st Floor
Boston, MA 02114
(617) 626-6565
www.mass.gov/DFML
More Information is Available
For more detailed information, please consult the Department’s website:
www.mass.gov/DFML.

33

ACKNOWLEDGMENT
Your signature below acknowledges your receipt of the information above within 30 days
from the start date of your employment.

_______________________________________________ __________________
Signature Date

___________________________________________________
Name (Print)

Your signed acknowledgement will be retained by your employer. Please retain a copy for
your own reference.

34

This Employee Benefits Guide describes the benefit plans and policies available to you as an employee of
Shields Health Care Group. Details of these plans and policies, including insurance contracts, are
contained in the official plan and policy documents. This Employee Benefits Guide is meant to cover only
the major points of each plan or policy; it does not contain all of the details that are included in your
Summary Plan Description (as required by ERISA). If there is ever a question about one of these plans
and policies, or if there is a conflict between the information in this Employee Benefits Guide and the
formal language of the plan or policy documents, the formal wording in the plan or policy documents will
govern. Please note that the benefits described in this Employee Benefits Guide may be changed at any
time and do not represent a contractual obligation on the part of Shields Health Care Group.