PUTTING YOU
F RST
2020
Team Member Benefit Guide
Contact 844-216-9320 or [email protected] for information about enrollment, effective dates,
and any benefit questions.
Para una guía en Español:
844-216-9320 o [email protected]
Welcome
Have a Smartphone? Benefit Effective
This Benefit Guide is equipped with mobile- Hire Date Range Date
friendly barcodes. These barcodes are more
commonly referred to as “Quick Response” or 10/4 - 11/3/19 1/1/2020
QR codes. Scanning these codes will take you to 11/4 - 12/4/19 2/1/2020
a new place on your phone, allowing you to see
new content. They might show you a website, 12/5 - 1/2/20 3/1/2020
video, or article. They can take you anywhere, 1/3 - 2/2/20 4/1/2020
you just have to scan them first.
2/3 - 3/3/20 5/1/2020
So How do I Scan Them? 3/4 - 4/3/20 6/1/2020
First, you’ll need one of the many free QR
Reader apps available for smartphones or 4/4 - 5/3/20 7/1/2020
tablets. Your phone may also be able to read 5/4 - 6/3/20 8/1/2020
them from within its camera app. After the
download, just open the app and follow the 6/4 - 7/4/20 9/1/2020
directions to scan the QR 7/5 - 8/3/20 10/1/2020
code. The app will read it
and immediately take you 8/4 - 9/3/20 11/1/2020
to that code’s content. 9/4 - 10/3/20 12/1/2020
Try it now on our 10/4 - 11/3/20 1/1/2021
benefits video library! 11/4 - 12/4/20 2/1/2021
Scan the QR code to
access quick informational videos 12/5 - 1/1/21 3/1/2021
about our benefits plans.
Your enrollment window opens 2 to 4 weeks
before your Benefits Effective Date. Your
benefit premiums will process on the first
paycheck of your month of eligibility. Additional
premiums will be recouped retroactively to the
coverage effective date in no less than two
Crystal Russell, Sales Support pay periods – so it pays to enroll early!
North East, MD
Since our theme this year is Putting YOU
First, we have featured our Team Members
and their families throughout the book!
See if your picture made it, or you might
spot a coworker’s submission!
Photos are identified by the Team Member
who submitted them.
Featured on the cover is a submission from Laura
Torres, a Credit Assistant at Houston, TX Windows.
1 1
Maricar Capulong, IT Engineer I
Dallas, TX
Table of Contents
LEARN YOUR WEALTH
3 What’s New for 2019 Wealth Protection
4 Preparing to Enroll 31 Short-Term Disability
5 Benefits Eligibility 33 Long-Term Disability
7 Frequently Asked Questions 35 Survivor Benefits
8 Mid Year Changes Wealth Building
37 Health FSA / Limited Purpose FSA
YOUR HEALTH 38 Dependent Daycare FSA
9 Virta - NEW for Type 2 Diabetics 39 Health Savings Account
10 Naturally Slim Program 40 401(k) Savings Plan
11 Medical/RX Plans
15 Where to Go For Care 41 Picture Gallery
17 Blue Care Connection
18 Member Rewards - NEW 43 Required Notices
19 Medical Plan Rates 49 Contact Guide
21 Pharmacy Benefits
23 Medical Gap Insurance
25 Vision Plans
27 Dental Plans
29 Employee Assistance Program
30 Tobacco Cessation Program
2
What’s New for 2020
Medical
Member You may be eligible for a cash reward when you shop for the most cost-effective
Rewards provider when receiving certain procedures or tests. Rewards range between
$25 and $500, depending on the service. Use Benefits Value Advisor (BVA)
to help you find an in-network provider participating in the Member Rewards
program. See p.18 for more information.
MDLive Virtual healthcare is expanding to include behavioral health services. You can
Behavioral schedule mental health services through MDLive at your convenience. Long and
Health short-term treatment is available for such issues as depression and anxiety, grief
and loss, eating disorders, addiction and more. See p. 15 for more information.
Virta Diabetes Introducing a voluntary program to help Type 2 diabetics covered in the medical
Management plan to better manage and even reverse the disease! See p. 9 for more information.
Hinge Health Introducing a non-surgical approach to chronic musculosketal and joint pain. This
Musculosketel voluntary program will be rolled out to medical plan members on a limited basis in
Solutions the first quarter of 2020. Be on the lookout for more information in the new year!
Medical Plan Medical plan premiums for both the Standard PPO Plan and the Consumer
Premiums HDHP Plan will increase slightly.
Provider BCBS has developed provider networks in various parts of the country offering
Network Change greater discounts on medical services. At this time, the greatest savings
for Team opportunities, with minimal disruption to employees, is available to those
Members in CO, employees residing in the states of Colorado, Florida, Georgia, Maryland,
FL, GA, MD, TN Tennessee and Wisconsin. (If you live in these states, you will be receiving
and WI a NEW BCBS ID card for 2020 reflecting the BCBS Select Network that
applies in your state. See p. 7). As BCBS further develops these networks
throughout the nation, other states may be added in future years. Your medical
benefits through the Select Networks is not changing! You still have the same
medical benefits available to you in either the Standard PPO Plan or the
Consumer HDHP, as reflected on p. 13.
Dental
Dental Dental premiums are increasing in 2020. See p. 28 for more information.
Premiums
Vision
Vision Premiums Vision premiums are increasing in 2020. See p. 25 for more information.
401(k) Savings Plan
401(k) Employer The employer matching contribution in the 401(k) plan is increasing on
Match 1/1/2020. The match is increasing from 30% of your 5% contribution to 40% of
your 5% contribution. See p. 40 for more information.
New Hire New hires/rehires (part-time and full-time) hired on or after 1/1/2020 will
Auto-Enroll automatically be enrolled in the 401(k) plan at a 1% contribution rate. See p. 40
for more information.
3
Preparing To Enroll
Log in to Dayforce to confirm your password is current. Login instructions for first-
time users are shown below.
View the benefits video(s) Share this information with your spouse (if
applicable).You can find them here: https://gspk.co/s/vwfxf9k or by
scanning the QR code.
Review each benefit option to determine which coverage is best for
you and your family.
Decide which eligible dependent(s) you will be covering and have their
birthdate(s) and Social Security Number(s) available when you are enrolling.
Once you have all your information ready, log in to Dayforce and click on the Benefits
icon. You’ll see a notice that you have an Enrollment available. Click on it and follow
the prompts through enrollment.
Use this guide for reference, and contact the Benefits Team at [email protected] or
1-844-216-9320 if you have any questions.
To log in to Dayforce:
1. Go to www.dayforcehcm.com
2. The company code is BUILDERS
3. Your username is your six digit employee number
4. If it is your first time to log in, the default password is your birth year + your six digit
ID. (Example: if your birth year is 1984 and your user number is 123456, your default
password would be 1984123456)
If you don’t remember your Dayforce Password, contact [email protected],
and include your ID number and a phone number they can call to contact you.
Your password will be reset. If you do not have a company email address, your manager
can submit a request on your behalf.
Ashish Mokashi, Manager Software Engineering
Dallas, TX
44
Benefits Eligibility
You are eligible to enroll for health and welfare benefits if you are classified as a
full-time employee who is regularly scheduled to work at least 30 hours per week.
If you are: Dependent Eligibility
; An existing employee making elections If you are eligible to elect coverage for
during 2020 Annual Enrollment (October yourself, you may also elect coverage for
28 through November 15, 2019): your eligible dependents.
Coverage will be effective on January 1, Your eligible dependents include:
2020. ; Your legal spouse
; New hire employee: Coverage will ; Your children up to age 26 (25 years
be effective on the first of the month old or younger) – including
coincident with or following 60 days of ; Natural children (born to you)
full-time employment (e.g., if you start ; Stepchildren
working on January 15, your benefits ; Adopted children
Children whose legal guardianship
;
eligibility date is April 1). A notice of has been granted to you by the
eligibility will be mailed to your home state
address. You must enroll within 31 days ; Your unmarried grandchild
of your benefit eligibility date. (See p.1 of under the age of 26 who is your
this guide for benefits eligibility dates.) dependent for federal income tax
; A newly-eligible employee due to a purposes
change in status from part-time to full- ; Your unmarried child age 26 and
time: Coverage will be effective on the older who depends solely on you for
first of the month following or coincident support because of mental or physical
with 60 days of full-time employment disability where the disability arose
based on your status date change. before age 26 (documentation is
required)
Dependent Verification
When you enroll dependents to your
medical coverage for the first time, you
will be contacted by mail to provide
documentation. Rehired employees may
also need to re-verify any dependents
enrolled in the medical plan. If you
disenroll a spouse in the medical plan
and later re-enroll the spouse, you will
be required to provide a recent tax return
or current proof of joint account. Please
ensure your address is
correct in Dayforce and
respond promptly.
Failure to provide this
documentation within 31
days of the enrollment
effective date, will result
in your dependents being removed from
the medical plan retroactive to the benefit
effective date. Scan the QR code for the
Eden Artino, Credit Analyst list of acceptable documents needed for
5 5 Houston, TX Windows dependent verification.
Chrystal Nolan, Sales Support Rep
Atlanta, GA Millwork
How will my spouse know if his/
her employer’s offer of coverage
is Qualifying coverage?
If your spouse’s employer offers health
coverage, the employer is required by
Working Spouse Exclusion from law to provide employees with a notice
Medical Coverage indicating whether the employer’s
An employee’s spouse who has access coverage meets affordability standards.
to affordable health care that provides Consult your spouse’s employer if you
minimum value (“Qualifying Coverage”, have questions about your spouse’s
as defined by the Affordable Care Act) health plan.
through another employer is not eligible
for enrollment in a Builders FirstSource Enrollment of your spouse in a medical
medical plan. This exclusion applies plan serves as certification that your
only to enrollment of your spouse in the spouse does not have access to
medical plan. You may freely enroll your Qualifying Coverage through his/her
spouse in other lines of coverage such as employer.
dental or vision.
What if my spouse or child and I
What is an offer of qualifying
coverage by an employer? both work for the company?
Your spouse is offered qualifying You may each enroll in the medical,
coverage if the medical plan offered is dental, and vision plans individually
1. “Affordable,” meaning your spouse’s as “Employee Only”, or you, or your
premium for the cost of the employee’s spouse may enroll as “Employee +
coverage does not exceed 9.78% of his/ Spouse” (or “Employee + Family”). You
her income and 2. provides “minimum cannot be enrolled as both an employee
value,” meaning the plan pays at least and a dependent. However, children of
60% of the total allowed costs provided parents who both work for the company
under the plan. can be covered by only one parent’s
plan. You cannot elect spouse life, or
spouse AD&D insurance if your spouse
is also a regular, full time employee of
the company.
6
Frequently Asked Questions
How do I find a provider? Do I need to enroll in a pharmacy Plan?
For a medical provider: http://www.bcbstx.com No. Your pharmacy benefit is included in your
Current Member: Log in to Blue Access for Members medical plan election; however, you will receive
(BAM) at www.bcbstx.com or on the BCBSTX mobile a separate ID card for prescriptions.
app. First-time users will need to register using the
member ID reflected on your ID card. Once logged How do I get benefit plan ID cards?
into BAM, select Provider Finder and perform your Your medical, prescription drug, dental and
search. When you are logged into BAM under your vision plan providers will mail ID cards to your
member ID, the system automatically brings up the home address. If the Company has your correct
correct BCBS network that applies to you. address on file, you should receive ID cards
within 15 business days of enrolling. If you are
To Search as a Guest: Go to www.bcbstx.com and needing a temporary ID card, please register
select Find a Doctor or Hospital. yourself on the BCBS, Caremark, MetLife, and/
• Click ‘Search as a Guest’. or Eyemed websites and an option to view your
• On the next page, click ‘Search In-Network card will be available. You can also contact the
Providers’. Benefits Department at [email protected] or
• In the drop-down box ‘How do you get insurance?’, call 844-216-9320.
select ‘Through my employer or my spouse’s
employer’. What if my spouse or child and I both
• In the drop-down box ‘Select the type of care you work for the company?
are looking for’, select ‘Medical’. You may each enroll in the medical, dental and
• Input in the next drop-down box the state where vision plans individually as “Employee Only,” OR
you live. you, or your spouse, may enroll as “Employee
• In the drop-down box for ‘Select Plan/Network’, + Spouse” (or Employee + Family”). You cannot
input the correct provider network selection from the be enrolled both as an employee and as a
table below. dependent. However, children of parents who
• Input the remaining fields to complete the search. both work for the company can be covered by
Know your BCBS Provider Network! only one parent’s plan. You cannot elect spouse
life or AD&D insurance if your spouse is also a
Resident State BCBS Provider Network regular, full-time employee of the company.
Colorado CO Pathway What if I need to add a dependent or
Florida Network Blue make changes to coverage after I enroll?
Georgia Blue Open Access POS Due to limitations required by law, generally
employees cannot make mid-year election
Maryland BlueChoice Advantage Open changes without a qualifying family status
Access change. Employees have 31 days from the
Tennessee Network S effective date of a qualifying family status
Wisconsin Blue Preferred POS change to make changes to their benefits.
See Mid-Year Changes on page 7 for more
All Other States Blue Choice PPO information on qualifying family status changes.
Or call BCBS Provider Finder at 1-800-810-2583, I have a question about my claim/benefit
Monday to Friday between 8 a.m. and 6 p.m. CT. deductions on my pay checks/leave of
For a MetLife dentist go to www.metlife.com absence/Dayforce benefits enrollment,
etc. Who do I contact?
• Click “I want to find a MetLife: Dentist” The Benefits Department can be your first
• Enter Zip Code point of contact to help direct you to the best
• Select your Network: PDP Plus resource. You can email [email protected] or
• Click “Submit” call 844-216-9320 (7am-6pm CST).
For a vision provider go to www.eyemed.com The “PPO in a suitcase” logo on the
• Click “Login” > “Member” front of your BCBS medical ID card
• Register using the last 4 of your SSN if you do means you are part of the BlueCard
not have a username and password program. This means you and
• Click “Locate a Provider” your covered dependents may use
Blue Cross and Blue Shield network providers
7 throughout the United States, even while
traveling or away from your home state.
Mid Year Changes
The only time you can make changes to your benefits outside of your new
hire and/or annual enrollment period is when you experience a family
status change event. Team Members must enroll new dependents or
make changes to your benefit elections within 31 days of the family status
change. If you do not make a change within 31 days of the effective date
of change your next opportunity to make changes will be the next annual
enrollment period in the Fall of 2020 for coverage starting January 1, 2021.
Submit your family change online in the Dayforce System at https://www.dayforcehcm.
com. The QR Code will take you to our Mid-Year Qualifying Events Chart providing
detailed guidance.
Here are some Qualifying Life Events
that allow you to change coverage.
Be sure to visit the link above for all possible QLEs, and what you can change for each.
NOTE: A Qualifying Life Event does NOT qualify you to change medical plans mid-year.
You get married, divorced, or
legally separated.
Rodney Hatch, Safety Coordinator Aaron Castillo, Inside Sales Rep
Shelby, AL Truss Houston, TX Millwork
You have a new child -
whether by birth or adoption.
Susie Montalbano, Assistant GM Pam Davidson, Office Administrator
Fairbanks, AK Lumber Millwood, WV Millwork
Your spouse or dependent gains or
loses coverage.
Lisa Pollock, Dispatcher Matthew Epler, General Manager
Winchester, VA Panel Fayetteville, NC Yard
Where applicable, additional premiums will be recouped
retroactively to the coverage effective date in no less than
two pay periods - so it pays to add dependents as soon as
they are eligible!
8
NEW for 2020!
Virta - For Type 2 Diabetics
Reversing type 2 diabetes with
Virta can taste great!
Virta uses the clinically-proven
combination of nutritional ketosis,
medical supervision, and one-on-
one health coaching. You also get all
the supplies you need for biomarker
tracking (scale, meter, blood glucose
and blood ketone strips, and
more), access to a private patient
community, and curated recipes, food
guides, and meal plans!
Learn more at www.virtahealth.com
What’s the cost?
There is no copay or out of pocket cost for
the treatment—Virta is fully covered for
those who qualify!
Who is Virta for?
Virta is available to employees, spouses
and adult dependents between the ages of
18 and 69 who are enrolled in an eligible
health plan. This benefit is offered to those
with type 2 diabetes.
Virta can help you:
; Lower blood sugar
; Decrease medications
; Reduce A1c
; Lose weight
; Lower triglycerides
How is Virta different?
4 No calorie counting
4 No fasting
4 No exercise required
4 No medication
4 No surgery
When is Virta available?
Access to Virta will open on
1/1/2020.
Richie Jimenez, Inside Sales Rep
9 West Palm, FL Yard
Naturally Slim www.naturallyslim.com/BFS
Ever wonder how some people can eat Is there a cost?
whatever they want and not gain weight? For eligible participants, the Builders
We’ll show you how it’s done. FirstSource medical plan pays 100% of
Naturally Slim® is a common-sense, the program with no out of pocket cost
online weight loss program based on to the participant. Program fees will be
Eatology™, the study of when, why and submitted to BCBS for processing.
how we eat. Unlike diets, which rely on
your willpower and ‘eat this, not that’ From real BFS Naturally Slim Participants:
advice, Naturally Slim teaches you simple, “I cannot believe this. I have lost 15
repeatable skills to help you lose weight pounds in 3 weeks with NO effort. I
and keep it off in the real world, while still have kicked my sugary drink habit. I am
eating the foods you love! sleeping better and have energy that I
didn’t know existed. I am so grateful for
Here’s how Naturally Slim works: this program.”
Instead of making you count points,
track calories or change your diet to kale “My wife said that I don’t snore like I used
smoothies, we use a science-based to. I’m not as loud and I snore less... After
approach based on the eating patterns 11 weeks I have lost 18 pounds and am
that people who don’t struggle with their looking forward to losing more.”
weight use naturally. During the initial 10
weeks of the program, you’ll log-in to your To learn more, visit
Naturally Slim dashboard to learn tips like: www.naturallyslim.com/BFS.
; Ways to enjoy your favorite foods
without going overboard
; How to manage the differences
between appetite and hunger
; How to keep thirst from hijacking your
weight loss
; The reasons we eat, many of which
have nothing to do with hunger
; How to stop eating around emotions
like stress, anger and depression
; How to sleep better, become more
physically active, reduce stress and
more!
Who’s eligible?
Employees, spouses, and adult
dependents age 18 and over who are
covered on the Builders FirstSource
medical plan are eligible to participate in
the program.
Marty Ellrick, Sales Product Manager
Grand Junction, CO 10 10
Medical Plan Choices
Standard PPO Plan Consumer HDHP Plan
$ 0 You pay nothing for $ 0 You pay nothing for
eligible in-network
eligible in-network
preventive care
preventive care
You pay your non-
For certain health care preventive medical and
services, you pay only a prescription expenses out-
copay and that’s it! The
copay applies to your out-of- of-pocket until you reach
pocket maximum. your annual deductible.
Certain services, like 20% Once the deductible is
surgery, apply to your met, you pay coinsurance
deductible. Once you meet of 20% for non-preventive
the deductible, you will medical and prescription
pay 30% for in-network expenses.
services.
If your out-of-pocket If your out-of-pocket
costs reach the annual costs reach the annual
maximum, the plan
maximum, the plan
care for the remainder 100% pays 100% for eligible 100%
pays 100% for eligible
care for the remainder
of the plan year. of the plan year.
TIP: If you contribute to a Health Flexible TIP: If you open a Health Savings Account
Spending Account with WageWorks, you through Fidelity, you can use the money
can use the money in your FSA to help in your HSA to help pay your out-of-
pay your out-of-pocket costs, including your pocket costs, including your deductible,
deductible, coinsurance and prescriptions. coinsurance & prescriptions.
This plan might be for you if... This plan might be for you if...
You/your dependents
You/your dependents expect only expect the usual
to have moderate to numerous preventive care services
non-preventive doctor’s office each year.
visits every year.
You want to allocate the
You have limited cash flow premium savings into an
HSA to pay the full cost of
and you like the security of set discounted non-preventive
office visit copay amounts for services up to the in-network
non-preventive services. deductible and out-of-
pocket maximums, should
You take several generic something unexpected occur.
maintenance medications that You can afford to pay the
are free to you in a 90-day full cost of medications up
supply through Mail Order or to the deductible and 20%
pick up at the CVS store. coinsurance thereafter
(deductible waived if drug is
on Preventive Therapy List).
11
Medical Plan Choices
Consumer HDHP Plan
Brittnie Read, Client Sales Rep
Polar Supply Anchorage, AK
All in-network preventive care services are offered at no cost to you, regardless of the
health insurance plan you are enrolled in, including:
• Annual physical exams (e.g. well-woman, well-child etc.)
• Preventive cancer screenings
• Preventive mammograms
• Biometric screenings (e.g. cholesterol, blood pressure, diabetes, etc.)
• Flu shots and other immunizations
• Diabetes prevention programs
DID YOU KNOW? The medical/RX plans offered through Builders FirstSource are self-
funded. This means we pay BlueCross BlueShield and CVS/Caremark to administer the
plans, pay claims and provide access to contracted providers, with whom discounts for
services and prescription drugs have been negotiated. We pay many millions of dollars
for these costs each year.
As employees, you share in the cost of the plan too. As consumers of healthcare
services in the plan, you can help hold down future cost increases by doing things like
making sure your medications are generic when possible, taking preventive steps to
avoid larger problems, and make sure to use the most cost effective care options (see p.
18 for more information.)
Medical ID Cards for 2020
If you are changing your medical plan and/or adding/removing dependents, you will
receive a new BCBS ID Card in the mail. If you continue with the same coverage and tier,
then no new ID Card will be sent to you. Members residing in CO, FL, GA, MD, TN and
WI will receive ID cards referencing the new BCBS Select Network Provider.
12
12
Medical Plan Choices
Standard Plan HDHP Consumer Plan
Premium Cost Higher Lower
Doctor Visit Copay
(for non-preventive care)
Telemedicine (see p. 15) $10 $44 (applies to deductible)
Primary Care Doctor $30 All costs up to Deductible, then
20% of Out of Pocket Maximum,
Specialist $50 then 0%.
Deductible (by coverage tier) You pay: You pay:
Employee Only $2,250 $2,000
Employee + 1 Dependent $3,375 $4,000
Employee + 2 or more $4,500 $4,000
Dependents
Coinsurance (% you pay 30% 20%
after Deductible)
Out of Pocket Maximum*
(by coverage tier)
Employee Only $6,350 $5,000
Employee and 1 Dependent $10,475 (limit of $6,350/person) $10,000 (limit of $5,000 per person)
Employee and 2+ $12,700 (limit of $6,350/person) $10,000 (limit of $5,000 per person)
Dependents
Preventive Care No cost to you No cost to you
Diagnostic Tests (x rays, labs) No cost to you (unless Deductible, then 20%
in-patient)
Emergency Room $300 copay, then 30% Deductible, then 20%
In-Patient Deductible, then 30% Deductible, then 20%
(hospitalization - all costs)
Out-Patient (all costs) Deductible, then 30% Deductible, then 20%
Imaging (CT/PET/MRI) Deductible, then 30% Deductible, then 20%
HSA Qualified Plan No Yes
Health FSA Qualified Plan Yes Not if contributing to the
HSA
* Medical and prescription drug deductibles, copays and coinsurance ALL apply to the annual Out of Pocket
Maximum. The Affordable Care Act requires the annual limit is satisfied when ONE individual covered in a
dependent coverage tier meets the Out of Pocket Maximum established for the ‘Employee Only’ coverage tier.
This table is only a summary. You should refer to the Summary Plan Description or contact BCBS or CVS
Caremark directly if you have questions concerning coverage.
13
HDHP
Standard Plan Consumer
Plan
Prescription Drug $100 per person (family limits apply) Unless
Deductible “preventive”,
applies to
deductible
Prescription Medications Up to 30-Day Supply 90-Day Supply Deductible,
Generic 25%, $15 Min., $30 Max. 0 then 20%
Brand/Formulary 40%, $35 Min., $100 Max. 30%, $40 Min., $200 Max. (Drugs on the
Brand/Non-Formulary 50%, $45 Min., $150 Max. 50%, $60 Min., $300 Max. Preventive Therapy
Insulin/Formulary 40%, $50 Copay Max. 30%, $150 Copay Max. List bypass the
Specialty RX 40%, $250 Max. N/A deductible.)
Wade Walania, Inside Sales Rep
Mankato, MN
14
14
Where to Go for Care
Confused About Where to Go for Care?
SmartER Care options may save you money.
SM
If you aren’t having an emergency, deciding where to go for medical care may save you time and money.
You have choices for where you get non-emergency care. Use the chart below to help you figure out when Freestanding ER
to use each type of care.
• Open 24 hours, seven
When you use in-network providers for your family’s health care, you usually pay less for care. Search days a week
for in-network providers in your area at bcbstx.com or by calling the Customer Service number on your Hospital ER
member ID card. • Open 24 hours, seven • Could be transferred
to a hospital-based ER
days a week depending on medical
• Average wait time is situation
four hours, seven • Services do not
Urgent Care minutes 4 include trauma care
Center • If you receive care • Often freestanding ERs
Virtual Visits Doctor’s Office Retail Health • Generally open evenings, from an out-of-network are out-of-network. If
provider, you may have
you receive care from an
weekends and holidays
• Available 24 hours a day, seven days • Office hours vary Clinic to pay more. Providers out-of-network provider,
outside the network
a week • Generally the best place to • Based upon retail • Often used when your may “balance bill” you, you may have to pay
• Access to care for non-emergency go for non-emergency care store hours doctor’s office is closed, which means they may more. Providers outside
and you don’t consider it
the network may “balance
medical issues or speak with a licensed an emergency charge you more than bill” you, which means
counselor, therapist or psychiatrist • Doctor-to-patient • Usually lower out-of-pocket your health plan’s fee they may charge you more
whether you’re at home or traveling relationship established cost than urgent care • Average wait time is schedule. than your health plan’s fee
3
• Visit with a health care professional and therefore able to • Often located in stores 16-24 minutes • Multiple bills schedule.
treat, based on knowledge
by calling 888-680-8646, going to of medical history and pharmacies to provide • Many have online for services such as • All freestanding ERs
MDLIVE.com/bcbstx or using the convenient, low-cost and/or telephone doctors and facility charge a facility fee that
MDLIVE mobile app 1 • Average wait time is treatment for minor check-in urgent care centers do
®
medical problems
2
• Medical: Average wait time is less 18 minutes not. You may receive
than 20 minutes. other bills for each doctor
• Behavioral Health: Can be scheduled you see. 5
24 hours a day, but consultations are
conducted by appointment.
$ $ $ $ $ $ $ $ $ $ $ $
If you need emergency care, call 911 or seek help from any doctor or hospital immediately.
MDLive is available 24/7/365! Payment is due at the end of the consult by
1 Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details.
Note: The relative costs described here are for independently contracted network providers. Your costs for out-of-network providers may be significantly
MDLive is great for: credit or debit card. You may also use your
higher. Wait times described are just estimates.
Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe.
Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe.
Virtual visits, Powered by MDLIVE may not be available on all plans. Virtual visits are subject to the terms and conditions of your benefit plan, including
; Cold & flu symptoms FSA or HSA card to pay for the service.
2 Vitals Annual Wait Time Report, 2017.
benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance
; Ear infections product or a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-
3 Wait Time Trends in Urgent Care and Their Impact on Patient Satisfaction, 2017.
controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians
4 Emergency Department Pulse Report 2010 Patient Perspectives on American Health Care. Press Ganey Associates.
reserve the right to deny care for potential misuse of services.
; Allergies Contact MDLive at 888-680-
5 The Texas Association of Health Plans.
The information provided in this guide is not intended as medical advice, nor meant to be a substitute for the individual medical judgment of a doctor or
other health care professional. Please check with your doctor for individualized advice on the information provided. Coverage may vary depending on your
; Pink eye 8646, on the website, or
through their app. A doctor
specific benefit plan and use of network providers. For questions, please call the number on the back of your member ID card.
; Short term prescription refills and more! will contact you in about 10
The copay is $10 per consultation for the minutes. The doctor can send a
Standard Plan PPO members. The consultation prescription to your pharmacy
fee for Consumer Plan members will be $44 electronically.
until the plan deductible is met; then 20%. MDLive now offers virtual behavioral
health options! Check out the app to
learn more!
15
Where to Go for Care
24/7 Nurseline
The 24/7 Nurseline can help you identify
some options when you or a family
member have a health problem or concern.
Confused About Where to Go for Care? Nurses are available at 800-581-0393, 24
SmartER Care options may save you money. hours a day, seven days a week, to answer
SM
your health questions.
If you aren’t having an emergency, deciding where to go for medical care may save you time and money.
You have choices for where you get non-emergency care. Use the chart below to help you figure out when Freestanding ER Urgent Care Center or Freestanding ER
to use each type of care.
• Open 24 hours, seven Knowing the Difference Can Save
When you use in-network providers for your family’s health care, you usually pay less for care. Search days a week
for in-network providers in your area at bcbstx.com or by calling the Customer Service number on your Hospital ER You Money! Urgent care centers and
member ID card. • Open 24 hours, seven • Could be transferred freestanding ERs can be hard to tell
to a hospital-based ER
days a week depending on medical apart. Freestanding ERs often look a lot
• Average wait time is situation like urgent care centers, but costs may
four hours, seven • Services do not
Urgent Care minutes 4 include trauma care be higher. A visit to a freestanding ER
Center • If you receive care • Often freestanding ERs often results in medical bills that may
Virtual Visits Doctor’s Office Retail Health • Generally open evenings, from an out-of-network are out-of-network. If be 10 times the rate charged by urgent
provider, you may have
care centers for the same services. Here
you receive care from an
• Available 24 hours a day, seven days • Office hours vary Clinic weekends and holidays to pay more. Providers out-of-network provider, are some ways to know if you are at a
outside the network
a week • Generally the best place to • Based upon retail • Often used when your may “balance bill” you, you may have to pay
• Access to care for non-emergency go for non-emergency care store hours doctor’s office is closed, which means they may more. Providers outside freestanding ER:
the network may “balance
and you don’t consider it
medical issues or speak with a licensed an emergency charge you more than bill” you, which means • Look like urgent care centers, but have
counselor, therapist or psychiatrist • Doctor-to-patient • Usually lower out-of-pocket your health plan’s fee they may charge you more the word “Emergency” in their name or
cost than urgent care
whether you’re at home or traveling relationship established • Average wait time is schedule. than your health plan’s fee
and therefore able to
3
• Visit with a health care professional treat, based on knowledge • Often located in stores 16-24 minutes • Multiple bills schedule. on the building.
by calling 888-680-8646, going to of medical history and pharmacies to provide • Many have online for services such as • All freestanding ERs • Are open 24 hours a day, seven days
MDLIVE.com/bcbstx or using the convenient, low-cost and/or telephone doctors and facility charge a facility fee that a week.
®
MDLIVE mobile app 1 • Average wait time is treatment for minor check-in urgent care centers do
medical problems
2
• Medical: Average wait time is less 18 minutes not. You may receive • Are not attached to and may not be
than 20 minutes. other bills for each doctor affiliated with a hospital.
5
• Behavioral Health: Can be scheduled you see. • Are subject to the same ER member
24 hours a day, but consultations are share which may include a copay,
conducted by appointment.
coinsurance and applicable deductible.
$ $ $ $ $ $ $ $ $ $ $ $
Find urgent care centers near you by
If you need emergency care, call 911 or seek help from any doctor or hospital immediately. texting URGENTTX to 33633.
1 Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Note: The relative costs described here are for independently contracted network providers. Your costs for out-of-network providers may be significantly
Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. higher. Wait times described are just estimates.
Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe.
Virtual visits, Powered by MDLIVE may not be available on all plans. Virtual visits are subject to the terms and conditions of your benefit plan, including
2 Vitals Annual Wait Time Report, 2017.
benefits, limitations, and exclusions. MDLIVE operates subject to state regulations and may not be available in certain states. MDLIVE is not an insurance
3 Wait Time Trends in Urgent Care and Their Impact on Patient Satisfaction, 2017. product or a prescription fulfillment warehouse. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA-
controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE physicians
4 Emergency Department Pulse Report 2010 Patient Perspectives on American Health Care. Press Ganey Associates. reserve the right to deny care for potential misuse of services.
5 The Texas Association of Health Plans.
The information provided in this guide is not intended as medical advice, nor meant to be a substitute for the individual medical judgment of a doctor or
other health care professional. Please check with your doctor for individualized advice on the information provided. Coverage may vary depending on your
specific benefit plan and use of network providers. For questions, please call the number on the back of your member ID card.
Clint Gollnick, Outside Sales Rep
Georgetown, TX 16 16
Blue Care Connection
Fitness Program
Blue Access for Members (BAM™) Members and covered dependents
Log on to BAM at www.bcbstx.com from (age 18+) are eligible for access to over
your smartphone, computer or tablet to 8,500 fitness centers nationwide for $25
access a provider directory, request an ID to sign up, $25 per month (per person)
card or check your claims. If you do not with NO contract. 1-888-762-2583
have internet access, contact BCBS
at the toll-free number on the back of your Blue Points - NEW FOR 2020!
ID card.
Working with Well On Target can help
you earn points that you can redeem
Blue Care Advisors Condition Support for gift cards and products! All you have
Clinical professionals are available to help to do is maintain you health and log on
you manage chronic health conditions to BAM at www.bcbstx.com and select
such as asthma, COPD, diabetes, heart Well on Target to start earning points by
disease, low back pain, etc. Participation participating in eligible fitness activities!
in condition support is voluntary and This free program will help you stay
completely confidential. Log on to BAM™ accountable to your health while
to learn more. helping you win things like electronics,
music, movies, and more!
My Blue Community
Online health and wellness
community that connects
you with other Blues plan
members from across the
country. You can share
information, tips and stories on a variety of Access to registered nurses who can
health and wellness topics, offer support and advise you on self-care or refer you to a
talk about ways to live healthier. Log on to provider. 1-800-581-0368
BAM™ to learn more.
A voluntary program for expectant mothers
1-888-721-7781
Blue 365 Member Discount Program
Register for this program and get access
to discounts on health and wellness
supplies and services. Available
programs and discounts vary. Log on to
BAM™ to learn more.
17
Member Rewards
As a member of Blue Cross and Blue Shield of Texas (BCBSTX) you have Member
Rewards. With Member Rewards, you can shop for medical care, compare costs and
maybe even earn a cash reward!
Member Rewards is quick and easy. Starting on 1/1/2020, shop online or by phone with a
Benefits Value Advisor (BVA). Your BVA will help you get the most out of your health plan
and the Rewards program by:
; Discussing your options and find a place for your
procedure
; Scheduling the procedure at the location of your
choice
; Assisting with changing your procedure location
And on top of the personalized service you’ll receive,
you could also be eligible for a cash reward when you
receive services from a reward eligible provider.
How it works:
1. SHOP
Search online via Provider Finder or call your BVA to
find a reward eligible location for your medical service
or procedure. Gretchen Kirschner, Design Sales Specialist
2. GO Alpena, MI Lumber
Receive a procedure or service at a chosen location.
3. EARN
After your claim is paid and the location is verified as reward eligible, a check will be
mailed directly to your home.
Don’t miss out on this great program you already have.
Get started today!
To reach a BVA, call the Customer Service number on the back of your ID card.
To shop online, go to bcbstx.com, register
or log in to Blue Access for Members and
click on the Doctors & Hospitals tab under
Provider Finder.
18
Medical Plans Rates
Bi-Weekly Payroll Deductions - PPO (Standard Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 47.07 51.93 53.92 64.92 78.73
Employee + Spouse 132.19 149.36 155.79 189.27 243.28
Employee + Children 109.35 123.64 128.59 144.82 167.62
Employee + Family 161.66 180.52 196.35 219.73 279.35
Weekly Employee Payroll Deductions - PPO (Standard Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 23.98 26.45 27.47 33.07 40.11
Employee + Spouse 67.34 76.09 79.36 96.42 123.94
Employee + Children 55.71 62.99 65.51 73.78 85.39
Employee + Family 82.36 91.96 100.03 111.94 142.31
Bi-Weekly Payroll Deductions - HSA Eligible HDHP (Consumer Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 34.91 39.33 41.34 52.43 66.26
Employee + Spouse 108.60 125.03 137.15 165.42 219.97
Employee + Children 87.75 101.35 106.39 122.67 145.44
Employee + Family 125.08 142.69 158.81 182.21 242.23
Weekly Payroll Deductions - HSA Eligible HDHP (Consumer Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 17.78 20.04 21.06 26.71 33.76
Employee + Spouse 55.32 63.69 69.87 84.27 112.06
Employee + Children 44.70 51.63 54.20 62.49 74.09
Employee + Family 63.72 72.69 80.90 92.82 123.40
Tobacco users pay an additional $22.22 biweekly or $11.32 weekly
(applies to EACH of the employee and spouse, if enrolled).
Want to remove the Tobacco surcharge? Check out p. 30.
19
Medical Plans Rates
Todd Wolf, Sales Product Manager
Boise, ID
How we Determine
What You Pay for Coverage
Employee premium withholdings for medical coverage are based on your annual
Base Pay Rate. The Base Pay Rate is established for each employee prior to the
annual open enrollment and a new hire’s initial coverage effective date.
The Base Pay Rate is determined as follows:
• Hourly Employees – Annualized base hourly rate of pay, not counting over-
time
• Salaried Employees – Base annual rate of pay, not counting bonuses
• Variable Pay & Commission-based Employees – Actual earnings from
piecework, weight or zone pay, and/or commission earnings received from
September 1, 2018 through August 31, 2019 are used for the 2020 annual
open enrollment. For newly eligible and employees with less than 12 months
of earnings, the Base Pay Rate will be projected.
Consider also that a change in your Base Pay Rate from last year may place you
in a different earnings tier for medical coverage. When you log into Dayforce to
enroll, you will see your costs for all coverages elected as you move through the
enrollment.
For benefits purposes, your Base Pay Rate is established once for the plan
year and will NOT change during the plan year.
20
Pharmacy Benefits
Caremark’s network includes CVS, Coverage of Contraception
for Women under Health Care
Walgreens, Target, Walmart, Longs, Reform
Rite Aid, Costco, Sam’s Clubs, and In accordance with the federal
most supermarkets and independent guidelines issued for Women’s
pharmacies (as of the printing of this Preventive Services as part of the Affordable
guide). Visit www.caremark.com for a Care Act, the plan provides coverage of the
current list of participating pharmacies, or full range of FDA-approved contraceptive
call 1-844-431-4881. methods at NO cost to the member for
generics and approved brand names. No-
Primary/Preferred Drug List cost contraception is available in both retail
The prescription drug plan follows the and mail order.
prescribing recommendations in the CVS
Caremark Primary/Preferred Drug List (CVS Step Therapy Program
Drug List). This list is periodically updated Certain classes of drugs require the
by the CVS Caremark National Pharmacy member to first try a less expensive, but
and Therapeutics Committee. Drugs may therapeutically equivalent, preferred drug
be removed from the CVS Drug List if they before ‘stepping up’ to a more expensive
become offered as a generic, are available brand name drug. The drug classes
over-the-counter (OTC), are discontinued requiring participation in the step therapy
by the manufacturer, and/or have other cost program can be found on the company
effective alternatives. The latest CVS Drug intranet.
List is available at www.caremark.com. To learn more about step therapy, visit the
Generics First Line of Prescribing link in the QR code at the top of the page.
This prescription drug plan automatically Maintenance Choice® for 90-day
substitutes a generic for a brand name drug Supply of Maintenance Drugs
when a generic equivalent is available. If you or a family member take a
maintenance drug to manage a chronic
health condition, such as high blood
pressure, asthma, diabetes, or high
cholesterol, you have a choice on how you
get your medications. You can get a 90-day
supply of your maintenance medications
through Caremark’s mail order system or
pick up your medicine at a neighborhood
CVS drug store – the choice is yours!
To learn more about Maintenance Choice,
visit the link in the QR code at the top of the
page.
Get the CVS/Caremark App
Get easy refills, timesaving
tools and convenient savings
with the app.
Isabel Pinon, Design Tech
Treasure Coast, FL
21
21
Enrollment in the pharmacy benefit plan occurs automatically
when you enroll in one of the Company medical plans. You will
receive a Caremark ID card to use when filling prescriptions.
Comparison of 90-Day Supply Choices
Advantages of Caremark Mail Order Advantages of CVS Drug Store
Pick up your medications directly from the CVS
Convenient home delivery
store when it is convenient for you
Confidential, tamper-resistant Same-day prescription availability
packaging
Talk to a pharmacist by phone Talk face to face with a pharmacist
Provisions that Apply Only to the
Provisions That Apply ONLY to the Standard PPO Plan
Consumer Plan (HDHP) Annual Deductible under the Standard PPO
The Consumer Plan combines the
deductible for both medical and prescription Plan
drug expenses. When you enroll in the You will pay the first $100 of the discounted
Consumer Plan, CVS Caremark will cost for prescription drugs for each member
administer your prescription drug coverage. of your family (limited to $200 for employee
Non-preventive prescription drug expenses plus one dependent, and limited to $300 for
will apply toward your medical plan Employee plus two or more dependents).
deductible and out-of-pocket maximum The annual deductible applies to non-
maintenance generic and brand-name drugs.
The Consumer Plan offers the same
Preferred Drug List or Formulary as the Tiered Copays
Standard Plan. When you fill a non- Covered prescriptions have tiered copays.
preventative prescription, you will pay the full
discounted cost of the medication until you These tiers are broken out for:
have met your deductible. Once you meet • Generic Drugs
the deductible, you will pay 20 percent of • Brand Name Formulary (preferred brand
the medication through coinsurance and the names)
plan will pay 80 percent, until you have met • Brand Name Non-Formulary (non-
your out-of-pocket maximum. preferred brand names)
• Specialty Prescriptions
Preventive Therapy Drug List
Under the Consumer Plan, IRS regulations
require that medications must be subject to
the deductible with the exception of specific
preventive medications. As a result, if you
are enrolled in the Consumer Plan and
taking a medication that is on the Preventive
Therapy Drug List, you will only pay 20
percent of the discounted cost of the drug;
the deductible will NOT apply for these
medications. CVS Caremark periodically
updates the Preventive Therapy Drug List
and is available on the Company intranet.
Note: A 90-day supply of FREE generic
maintenance medications is NOT available
on the Consumer Plan, except as required Collette Boyd, IT Data Analyst
by law, such as women’s contraceptives. Dallas, TX 22 22
Medical Gap Insurance
Benefits Provided Dependent Eligibility
The Gap Plan is a fully insured product If your dependents are eligible for
offered through Sun Life Financial. coverage in the BCBS Medical Plan
This plan provides payment to you for sponsored by the Company, they are
out of pocket expenses due to hospital eligible for enrollment in the Gap Plan.
confinements and outpatient treatment Individuals in your family on whom you
for a covered injury or sickness up to the expect to receive reimbursement under
plan’s annual calendar year limits. the Gap Plan must also be enrolled in the
Medical Plan.
Sun Life looks only to the BCBS EOB to
substantiate your out-of-pocket costs in
determining your reimbursement under the
Gap Plan. It is permissible for you to claim
the same expense under a health flexible
spending account, if applicable. A medical
GAP claim form is located on the company
Intranet.
Cost of Coverage
The cost of coverage in the Gap Plan is
100 percent paid for by the employee. The
premiums are age-banded, based on the
employee’s age as of January 1, 2020.
Premiums are withheld on a pre-tax basis.
Dan Magno, Sales Product Manager *Enrollment in the Medical Gap Plan is
Albuquerque, NM Lumber contingent on enrollment in one of the
company sponsored medical plans where
you are NOT also contributing to a Health
Savings Account (HSA).
Weekly Rates Bi-Weekly Rates
<40 40-49 50+ < 40 40-49 50+
Employee 8.05 11.02 18.02 15.80 21.64 35.37
Employee + 14.50 19.84 32.42 28.46 38.94 63.64
Spouse
Employee + 17.86 20.33 29.25 35.05 39.92 57.41
Child(ren)
Employee + 24.30 29.14 43.64 47.69 57.21 85.67
Family
23
800-648-8624
www.slfserviceresources.com
MAX BENEFIT
WHAT IS COVERED
PER PERSON
In Patient Benefits • Hospital confinement due to a covered
Pays benefits up to illness or injury
the amount shown, per • Hospital emergency room treatment $4000
covered person, per
calendar year
Outpatient Benefits • Outpatient treatment due to a covered
Subject to a per family/per injury or sickness at a hospital $2000
calendar year maximum • Outpatient surgical or emergency not to exceed
of two individuals facility or a diagnostic testing facility or $4,000 per family
similar facility that is licensed to provide per year or two
outpatient treatment individuals covered
• This includes radiation and in the year
chemotherapy.
Not Covered • Copays for office visits and prescription
drugs
• Expenses not covered by the BCBS
Medical Plan
• Expenses related to mental/nervous
disorders or treatment for substance $0
abuse (even though such expenses ARE
covered by the BCBS Medical Plans)
• Otherwise eligible expenses which are
paid by the Medical Plan at 100%; only
expenses applied to deductible and
coinsurance are reimbursable.
Jina Pyun, Senior Benefits Analyst
Dallas, TX
24
24
Vision Plan
Basic Plan*
Exam with Dilation as Necessary $10 Copay
Exam Options:
Members <19: Standard Contact Lens Fit & Follow-Up N/A
Members <19: Premium Contact Lens Fit & Follow-Up N/A
Adults: Standard Contact Lens Fit & Follow-Up N/A
Adults: Premium Contact Lens Fit & Follow-Up N/A
Frames: Any available frame at provider location 35% off retail
Standard Plastic Lenses:
Single Vision $50 Copay
Bifocal $70 Copay
Trifocal $105 Copay
Lenticular N/A
Standard Progressive Lens $135 Copay
Premium Progressive Lens N/A
Lens Options:
UV Treatment $15 Copay
Tint (Solid and Gradient),Standard Plastic Scratch Coating $15 Copay
Standard Polycarbonate – Adults and Kids $40 Copay
Standard Polycarbonate – Kids < 19 $40 Copay
Standard Anti-Reflective Coating $45 Copay
Polarized 20% off Retail
Photochromic/Transitions Plastic – Adults N/A
Photochromic/Transitions Plastic – Kids <19 N/A
Other Add-Ons 20% off Retail
Contact Lenses (Contact lens allowance includes materials only)
Conventional 15% off Retail
Disposable N/A
Medically Necessary N/A
Laser Vision Correction 15% off Retail
Lasik or PRK from U.S. Laser Network Price or 5% off
promotional price
Additional Pairs Benefit: N/A
Bi-Weekly Payroll Deductions Weekly Payroll Deductions
Basic Enhanced Basic Enhanced
Vision Vision Vision Vision
Employee Only $0.54 $2.33 Employee Only $0.28 $1.19
Employee + Spouse $1.04 $4.44 Employee + Spouse $0.53 $2.26
Employee + Children $1.21 $5.19 Employee + Children $0.62 $2.64
Employee + Family $1.79 $7.67 Employee + Family $0.91 $3.91
25
To locate a provider near you, call
1-866-939-3633 or go to
www.enrollwitheyemed.com/access
Enhanced Plan
Exam with Dilation as Necessary $10 Copay
Exam Options:
Members <19: Standard Contact Lens Fit & Follow-Up $0 Copay, Paid-in-Full w/2 follow-up visits
Members <19: Premium Contact Lens Fit & Follow-Up $0 Copay, 10% off retail, then $55 allowance
Adults: Standard Contact Lens Fit & Follow-Up Provider may charge you up to $55
Adults: Premium Contact Lens Fit & Follow-Up 10% off retail
Frames: Any available frame at provider location $0 Copay; $130 Allowance, then 20% off
balance
Standard Plastic Lenses:
Single Vision $25 Copay
Bifocal $25 Copay
Trifocal $25 Copay
Lenticular $25 Copay
Standard Progressive Lens $90 Copay
Premium Progressive Lens $90 Copay, 80% of Charge less $120
Allowance
Lens Options:
UV Treatment $15 Copay
Tint (Solid and Gradient),Standard Plastic Scratch Coating $15 Copay
Standard Polycarbonate – Adults and Kids $15 Copay
Standard Polycarbonate – Kids < 19 $40 Copay
Standard Anti-Reflective Coating $0 Copay
Polarized $45 Copay
Photochromic/Transitions Plastic – Adults 20% off Retail
Photochromic/Transitions Plastic – Kids <19 80% off Retail
Other Add-Ons $0 Copay
20% off Retail
Contact Lenses (Contact lens allowance includes materi-
als only) $0 Copay, $105 allowance, 15% off balance
Conventional over
Disposable $0 Copay, $105 allowance, plus balance
Medically Necessary over$105
$0 Copay, Paid-in-Full
Laser Vision Correction 15% off Retail Price or 5% off promotional
Lasik or PRK from U.S. Laser Network price
Additional Pairs Benefit: 40% discount off complete pair
BASIC PLAN ENHANCED PLAN
Frequency All Members ≥19 Years Old < 19 Years Old
Examination 1x every 12 months 1x every 12 months 2x every 12 months
Lenses No limit (discount only) 1x every 12 months 2x every 12 months**
Frame No limit (discount only) 1x every 12 months 2x every 12 months
Contact Lens (no lenses) No limit (discount only) 1x every 12 months 2x every 12 months
*No Out of Network benefit, except for Exam reimbursement limited to $23.
**For members under 19 years of age, if vision RX changes within the benefit period, the
member is entitled to an additional standard eyeglass lens benefit. 26
Dental Plan
The Company offers two dental plans through MetLife. Both plans let you go to any
dentist you choose - but you’ll pay less when you visit one who is a member of MetLife’s
Preferred Dental Program network.
Pre-treatment Estimate How to Access Benefits
To assist you in budgeting for dental out-of- When you enroll for dental coverage,
pocket costs, it is recommended that you or you will receive an ID card from
your dentist request a pre-treatment estimate MetLife. Register for MyBenefits on
for any services that may cost more than $300. MetLife’s website, www.metlife.com/
This often applies to services such as crowns, mybenefits. On this website, you can
bridges, inlays and periodontics. To get an also find a provider, print an ID card,
estimate, have your dentist submit a request learn about plan benefits and check
online at www.metdental.com or call 1-877- the status of a claim. You can also
638-3379. You and your dentist will receive a call MetLife’s Customer Service at
benefits estimate – for most procedures – while 1-800-474-7371.
you’re still in the dentist’s office.
Plan Provisions Basic Dental Plan Enhanced Dental Plan
Deductible (Applies to Non- $75 per Individual $75 per Individual
Preventive Services) $225 Family Limit $225 Family Limit
Preventive Type A Services – You pay: $0 You pay: $0
checkups, cleanings, x-rays
Basic Type B Services – You pay: Deductible You pay: Deductible +
fillings, extractions + 30% 20%
Major Type C Services – You pay: Deductible You pay: Deductible +
crowns, implants, root canals, + 60% 50%
etc.
Annual Plan Limit per Covered $1,000 $2,000
Individual
Orthodontia (available to Not covered You pay: 50% of
dependent children under age allowable charges up
26 only) to the plan’s lifetime
maximum of $1,500;
100% of charges in
excess of plan’s lifetime
maximum.*
* A child must be covered under the dental plan prior to the commencement of an
orthodontia treatment program.
27
To locate a provider near you, call
1-800-474-7371 or go to
www.metlife.com/mybenefits
2020 Builders First Source Bi-Weekly Payroll Deductions
Basic Dental Enhanced Dental
Employee Only 10.76 15.73
Employee + Spouse 21.41 31.46
Employee + Children 22.96 28.37
Employee + Family 35.87 48.00
2020 Builders First Source Weekly Payroll Deductions
Basic Dental Enhanced Dental
Employee Only 5.48 8.01
Employee + Spouse 10.91 16.03
Employee + Children 11.69 14.45
Employee + Family 18.27 24.45
MetLife Smartphone App
You can:
; Find a dentist
; Get estimates for most
procedures
; View your plan summary
; View your claims
; Track your brushing and flossing
; View your ID card
Search “MetLife” at iTunes
App Store or Google Play
to download the MetLife US
Mobile App,
Philip Shoemaker, Design Tech
Jacksonville, FL Truss
28 28
Employee Assistance
The Employee Assistance Program Legal Support & Resources
(EAP) can help you manage the daily Talk to attorneys by phone. If you require
stress of work, home and family life. representation, you’ll be referred to a
Employees and immediate family qualified attorney in your area for a free
members can use the EAP free of charge. 30-minute consultation with a 25 percent
Guidance Resources offers face-to- reduction in customary legal fees thereafter.
face consultations, over-the-phone Call about:
consultations and online resources. ; Divorce and family law
; Debt and bankruptcy
The EAP can help with: ; Landlord/tenant issues
; Real estate transactions
Confidential Counseling ; Civil and criminal actions
No-cost short-term counseling services
available for relationship and other Work-Life Solutions
personal issues you and your family Work-Life specialists will do the research
may face. Trained clinical counselors for you, providing qualified referrals and
are available telephonically or get a customized resources for:
referral for up to five in-person counseling ; Child and elder care
sessions per family member, per year for: ; Pet care
; Stress, anxiety and depression ; Moving and relocation
; Relationship/marital conflicts ; Home repair
; Problems with children ; Estate Planning, Wills
; Grief and loss
; Substance abuse GuidanceResources® Online
GuidanceResources Online is your one
Financial Information & Resources stop for expert information on the issues
Speak by phone with Certified Public that matter most to you: relationships, work,
Accountants and Certified Financial school, children, wellness, legal, financial,
Planners on a wide range of financial free time and more.
issues, including:
; Getting out of debt
; Credit card or loan problems
; Tax questions
; Saving for college or retirement
If you should require additional guidance,
you can be referred to a financial
professional for an initial one-hour in-
person consult at no cost to you.
Call the toll-free EAP line 24-hours
a day, 7 days a week at 1-888-327-
7401, or visit them online at www.
guidanceresources.com using the
company ID “BFSEAP”.
Frank Rolfes, General Manager
Longmont, CO Millwork
29
Tobacco Cessation
Tobacco & Nicotine Cessation Program
Employees and/or spouses who are The program uses the 4 Essential
enrolled in a Company-sponsored medical Practices to Quit For Life:
plan and paying a tobacco surcharge ; Quit At Your Own Pace – Quit on your
will have the surcharge removed upon own terms, but get the help you need,
completion of five Quit Calls with the when you need it.
program. ; Conquer Your Urges to Smoke -
Gain the skills you need to control
The Quit for Life ® Program is the nation’s cravings, urges and situations
leading tobacco and nicotine cessation involving alcohol.
program. It can assist you in overcoming ; Use Medications So They Really
physical, psychological and behavioral Work - Learn how to supercharge your
addictions to tobacco and/or nicotine quit attempt with the proper use of
through coaching, a customized quitting nicotine substitutes or medications.
plan and a supportive online community. ; Don’t Just Quit, Become a Non-
Tobacco User – Once you’ve stopped
Expert Quit Coaches® help participants using tobacco, learn to never again
gain the knowledge, skills and behavioral have that “first” cigarette.
strategies to quit for life. Participants have
unlimited access to phone- and web-based You or a loved one could be the next
coaching as well as to Web Coach®, person we help quit tobacco.
an online community for e-learning and
social support. Participants also receive a The program is free, confidential, and
workbook that helps guide them through the it works.
quitting process.
Call 1-866-QUIT-4-LIFE (1-866-784-8454) or log on to www.quitnow.net for details
or to enroll.
When accessing the program on the website: www.quitnow.net
1. Enter “Builders FirstSource” as the Employer.
2. Skip to item 3 and enter your zip code.
3. Follow the remaining steps to register.
The average cost of
cigarettes for a year is
more than $2,000!
30
Short Term Disability
The Short-Term Disability (STD) Plan is a voluntary, self-insured plan you can elect
to provide income protection for non-work related illness or injury. The plan is designed
to provide income protection for disability absences greater than 14 days, but no longer
than 13 weeks in duration. You pay the full cost for coverage and you must enroll in the
plan to receive the benefit.
Benefits are payable for non-work related illness or injury after 14 consecutive days of
disability. If your absence is expected to be 14 days or less, you will not have a benefit
payable under this plan. The plan begins payments on the 15th day following your date
of disability. The plan will pay you 70 percent of your base rate of pay for up to 11 weeks,
as long as your disability is properly substantiated by your treating physician.
Once Sun Life has approved your claim, they will notify you and the Company. Your STD
benefit will be paid to you by the Company on the next scheduled payroll run. Your usual
deductions will be withheld from your STD benefit payment.
If you do not enroll in the STD plan when you are first eligible, you may enroll during the next
annual enrollment. Evidence of Insurability (EOI) is not required to enroll in the STD plan.
Plan Features Short Term Disability Long Term Disability (see p 33)
70% of base wage—no 60% of base wage, limited to
Plan Pays
limit $10,000/month
On 15th day of On 91st day of disability
Benefit Payment Starts
disability
11 weeks from benefit To Social Security Normal
Maximum Benefit payment start Retirement Age, depending on
Period
age at disability
100% Employee Paid Shared:
Who Pays for 58% Paid by Employee
Coverage
42% Paid by Employer
Cost of Coverage $.42 per $100 $.255 per $100
Not required No, when first eligible; yes, as a
Proof of Good Health
late enrollee
Pre-Existing Condition No Yes, if enrolling as a late enrollee
Exclusion
Note: This plan will offset against any benefits received under state-mandated disability.
Employees in the states of California, New Jersey, and New York (at the time of this publication)
may be impacted.
31
Calculate Your Cost for Short-Term Disability
Your premium is determined by your base rate of pay. These premiums are withheld
on a pre-tax basis. When using automated enrollment, your cost for coverage will
automatically populate. Here is the formula used to calculate your premium:
Example
Here is the formula to calculate your cost for the STD coverage:
# of Units
___________________ / 100 = ____________ x .42 = ______________
Weekly Premium
Your Base Weekly Pay
Per Paycheck
# of Pay Periods*
Then, __________________ x 52 / _________________ = _____________
Weekly Premium
*26 if paid Bi-Weekly or 52 if paid weekly; in 2020, use 53 for weekly pay
periods and 27 for bi-weekly pay periods
How to Report a Disability Claim
Call Sun life at 833-812-5177. Please have this information handy:
; Your name, address, phone number, birth date, date of hire, Social Security number
; Your employer’s name, address and phone number
; Date of your claim and when you plan to return to work
; If you’re pregnant, give your expected delivery date
; Name, address and phone number of each doctor you are seeing for this absence
Sara Zappone-Alfree, Inside Sales Rep
Johnstown, NY Lumber
32 32
Long Term Disability
The Long-Term Disability (LTD) Plan 12 consecutive months. A pre-existing
is a fully-insured plan offered through condition is a sickness or injury for which
Sun Life. Enrollment in the LTD plan is you, during the three months prior to your
voluntary. The plan is designed to provide coverage effective date, received medical
income protection to you during times of treatment, consultation, care or services;
extended illness or injury over several took prescription medication or had
months or even years, depending on medications prescribed.
your age at the onset of disability. If you
are receiving benefit payments under the The plan imposes a 24-month benefit
STD plan and become eligible for LTD, duration limit for certain illnesses such
your claim will automatically transition to as mental/nervous conditions, chemical
Sun Life’s LTD claims unit. LTD payments dependency, chronic fatigue and
will be paid to you directly by Sun Life, fibromyalgia.
beginning on the 91st day of disability. You
can see more ways to compare LTD and Cost of Coverage
STD on p. 31. The Company shares the cost of LTD
coverage with you. In the event of your
Plan Benefit disability, the portion of the benefit you
Benefits are payable for illness or injury receive under the plan attributable to
after 90 continuous days of disability your share of the cost of coverage is not
with benefit payments to begin on your taxable to you. The portion of your benefit
91st day of disability. The plan will pay payment attributable to the shared cost
60 percent of your base rate of pay in paid by the Company is taxable to you.
effect prior to your date of disability up
to a limit of $10,000 per month. Your Calculate your cost for Long-Term
monthly benefit under the plan will be Disability
offset for other household income, such as Your premium is determined by your
social security or worker’s compensation base rate of pay. These premiums are
earnings. withheld on an after-tax basis. When
using Dayforce enrollment, your cost for
Plan Limitations and Exclusions coverage will automatically populate. The
The plan does not cover disability due formula used to calculate your premium is
to a pre-existing condition until you on the next page.
have been covered under the plan for
Example
Here is the formula to calculate your cost for the LTD coverage:
Your Base Monthly Pay
# of Units
_______________________ / 100 = ____________ x .29 = ________________
Monthly Premium
Per Paycheck
# of Pay Periods*
Then, __________________ x 12 / _________________ = _____________
Monthly Premium
*26 if paid Bi-Weekly or 52 if paid weekly; in 2020, use 53 for weekly pay periods and 27
for bi-weekly pay periods
33
Enrollment Subsequent to Initial
Eligibility Greg Jacobs, Manager Yard Operations
Unlike the STD plan, if you do not enroll in Palmer, AK Lumber
the LTD plan when you are first eligible (as
a new hire), enrollment during a subsequent
enrollment period will be subject to proof
of good health and Sun Life’s approval.
Likewise, if you are currently enrolled in the
LTD plan, and decide to cancel coverage for
the upcoming plan year, you will be subject
to proof of good health to re-elect coverage
in a subsequent enrollment period.
Maximum Benefit Period
The Maximum Benefit Period defines the
maximum length of time for which benefits
are payable under the plan, provided
you remain continuously disabled. The
Maximum Benefit Period most typically
pays until you reach Social Security
Normal Retirement Age (SSNRA),
depending on your age at onset of
disability, per the schedule below.
Age at Maximum Benefit
Disability Period
< 60 To SSNRA How to Report a Disability Claim
60 60 Months* Call Sun life at 833-812-5177. Please
61 48 Months* have this information handy:
62 42 Months* ; Your name, address, phone number,
birth date, date of hire, Social Security
63 36 Months* number
64 30 Months* ; Your employer’s name, address and
phone number
65 24 Months* ; Date of your claim and when you plan
66 21 Months* to return to work
67 18 Months* ; If you’re pregnant, give your expected
68 15 Months* delivery date
69+ 12 Months* ; Name, address and phone number
of each doctor you are seeing for this
*or SSNRA, whichever is longer absence
34
Survivor Benefits What happens to those you love if something
happens to you?
Life and Accidental Death & Dismemberment Insurance - The Company provides you
with 100% company-paid Basic Life and AD&D. The coverage equals your annual base
pay, rounded to the next $1,000 up to $500,000.* You have the option to purchase additional
coverage for yourself, your spouse and your children.
Make sure to designate a beneficiary, even if you don’t elect additional coverage! If
you do not name a beneficiary, your life insurance proceeds will be distributed to either your
estate or equally among your immediate family members – if we can identify and find them!
Minor Children – If you name a minor child as a beneficiary, the insurance company will
NOT pay proceeds directly to a minor child. Depending on the state, a guardian will need
to be appointed who can accept the proceeds on behalf of the child – a complex and
often costly process! A better option is to name a trusted adult or set up a trust to accept
the proceeds.
Optional Life and Voluntary AD&D Eligible Dependents for Spouse and
You have the option to purchase additional Child Life and AD&D:
coverage for yourself, your spouse and ; Your current legal spouse;
your children. The premium cost for ; An unmarried child from live birth to
optional coverage is paid by you through age 26 (meaning 25 years of age or
payroll deductions. Enrollment in Optional younger);
Life and Voluntary AD&D are separate ; An unmarried child age 26 and above
elections. who is financially dependent on you
due to a disability
The Company will not seek to verify you
have enrolled an eligible dependent in
these plans. If you enroll an ineligible
dependent for life insurance or AD&D,
there will be no benefit payout in the event
of a loss. Your dependents who are insured
under these plans as an Employee of the
Company may not also be insured as a
dependent.
Paul Johnston, Manager Installation
Great Falls, MT Lumber
35
35
35
What happens to those you love if something
happens to you?
Optional Life and Voluntary AD&D Coverage – Employee, Spouse & Child
Amount Available
Employee Minimum of $10,000 up to 8X annual base pay (rounded to
the next $10K)
Spouse Spouse Life I: $5,000 to $45,000 (in increments of $5,000)
Note: Spouse Life cannot Spouse Life II: $50,000 to $250,000 (in increments of
exceed Employee’s combined $25,000)
Basic & Optional Life.
Child $15,000 or $20,000
Rates for both Employee Optional Life and Spouse Life are age-banded using the
employee’s age for Employee Optional Life and the Spouse’s age for Spouse Life.
Age Monthly Rate per
$1,000 of Coverage
<25 .04 Here is an example of how the cost for
25-29 .05 employee optional life (or Spouse Life) is
calculated for an individual (Employee or
30-34 .07 Spouse), age 42 who elects $100,000 of
35-39 .09 coverage.
40-44 .10 To determine cost per paycheck:
45-49 .15 ($100,000/1,000) x .10 = $10.00 per
50-54 .23 month. Then ($10.00 x 12) / 26*=$4.62
55-59 .37 per paycheck.
60-64 .66 *Use 52 instead of 26 if paid weekly;
65-69 1.27 in 2020, use 53 for weekly pay periods
70+ 2.06 and 27 for bi-weekly pay periods
*Reduction for age applies to Basic Life and AD&D at age 65 and 70. The benefit reduces to 65%
at age 65 and to 50% at age 70. Reduction for age does NOT apply to Optional Life and AD&D for
either the Employee or Spouse.
**Evidence of Insurability (EOI) may apply to Employee and Spouse Optional Life.
EOI is never required for Vol. AD&D or Child Life. EOI Guidelines can be viewed on
the Intranet.
36
Health FSA & LPFSA
What are they, and should I consider enrolling? Enrollment in these
The Company offers two types of accounts that may reimburse accounts is never
you for your eligible out-of-pocket expenses; a Health Care automatic. It is
Flexible Spending Account (FSA) and a Limited Purpose Flexible mandatory that you
Spending Account (LPFSA). actively enroll in your
FSA each year.
Health FSA LPFSA
Which medical plan Standard PPO Consumer HDHP with HSA
is this account Consumer HDHP
available for? You don’t need to be enrolled in
a medical plan to contribute to a
Health FSA.
What would I use Eligible healthcare expenses, This health care account
this account for? including dental, vision and is only available if you are
prescription medication contributing to an HSA and
expenses. you can only use it for eligible
vision and dental expenses.
What is the $2,700 - the IRS pre-tax $2,700 - the IRS pre-tax
maximum amount contribution limit as of this contribution limit
I can contribute to writing as of this writing
this account?
When are the funds Your entire goal amount is Your entire goal amount is
available? available at the beginning of the available at the beginning of
benefit period. the benefit period.
What happens You will forfeit amounts not You will forfeit amounts not
if I don’t use the claimed for expenses incurred claimed for expenses incurred
money during the during the benefit period. during the benefit period.
year?
Contribution Yes Yes, to end of year in which
allowed for Medicare enrollment first
Medicare enrolled? occurs
Provider Contact WageWorks - 1-877-924-3967 WageWorks - 1-877-924-3967
How to File FSA Claims
File claims with WageWorks through March 31, 2021 for 2020 FSA expenses
incurred through December 31, 2020. Log on to www.wageworks.com or
use the WageWorks EZ Receipts mobile app, available in the App Store and
Google Play.
37
Dependent Care FSA
The Dependent Daycare FSA offers a Forfeiture of Benefits
convenient way to use pre-tax dollars Be conservative in estimating health and
to pay for eligible child and elder care dependent care expenses. You will forfeit
expenses (generally expenses you incur amounts remaining in your Health Care
so that you can work). Enrollment is not and/or Dependent Care FSA account(s) for
automatic. You must actively enroll in the which you are unable to claim reimbursable
Dependent Care FSA each year. expenses. Funds DO NOT roll over from
year-to-year. Unlike an HSA, you must use
Contributions are deducted from each the funds in your FSA by December 31,
paycheck and deposited into an account 2020, or you lose them. Deadline for claims
that may be accessed with a claim form.
submission: All claims for reimbursement
The Dependent Daycare FSA has for the 2020 plan year must be filed with
IRS limitations of $5,000 per year and WageWorks prior to March 31, 2021.
further limitations for certain married Expenses You Can Pay with a
participants. Your taxable income will be Dependent Daycare FSA:
reduced by the amount you set aside for Child Care (while you work) for child(ren)
your FSA every pay period. It is important under age 13, provided by
to estimate the amount of your out-of- ; After school program
pocket expenses carefully and plan your ; Daycare center
payroll contributions accordingly. ; An individual who is NOT also your tax
dependent
Unlike Health FSA, the Dependent Care ; Summer day camp
FSA can only reimburse you for amounts
you have on deposit as you incur claims. Elder Care (of your tax dependent)
You must incur reimbursable Dependent ; In your home
Care expenses during the 2020 plan year ; Adult daycare
or during your benefit period if enrolling
as a newly eligible employee.
NOT REIMBURSABLE:
Before you enroll in Dependent 4 Health care expenses of your child or
Daycare FSA, note this account is other dependent
NOT for reimbursement of depen- 4 Babysitting for non-work related
dent health care expenses! activities
Do not enroll in this plan unless you 4 Dance lessons
expect to incur eligible expenses, 4 Tutoring services
such as daycare services that can be 4 Field trips
substantiated with a receipt. 4 Dog walking
Astrid Morales, Office Manager
Also consider: Compare the Dependent Tampa, FL Yard
Daycare FSA to the Federal dependent
care tax credit to see which approach
provides you with the better tax
advantage. In some cases, you may
be able to split your eligible expenses
between a Dependent Care FSA and the
tax credit. You may wish to consult your
tax advisor.
3838
Health Saving Account (HSA)
If you are looking for ways to boost your As a first time participant, you must
savings and plan for retirement medical contact Fidelity to open your Health
expenses, consider enrolling in our BCBS Savings Account.
Consumer High Deductible Health Plan to
take advantage of the Fidelity Health Savings Log on to Fidelity via netbenefits.com,
Account (HSA). You can benefit from - choose the Health Savings Account tile
; Triple tax savings – your contributions, any and click “open your account.”
earnings, and withdrawals are tax free*
when used to pay for qualified medical After your Health Savings Account
expenses. is established, you may request a
; Any unused money in your HSA carries Fidelity HSA Debit Card
over each year and is yours to keep, even (checks are available
if you change employers. upon request). Scan the
; You have the opportunity to invest your QR code for detailed
contributions, giving them the potential to information about enrolling
grow for future use, including retirement. in your Fidelity Health
Savings Account (HSA).
What is the maximum $3,550 Employee Only Coverage
amount I can $7,100 Family Coverage
contribute to this If you’ll be at least 55 years old in 2020, you can make an
account? additional $1,000 catch up contribution
Your contribution amount is available as it comes out of your
When are the funds paycheck each pay period - so your entire contribution is not
available? available at the beginning of the benefit period.
What happens if I All unused funds will remain in your HSA. You can take HSA
don’t use the money funds with you when you leave the company or retire.
during the year?
Fidelity - www.netbenefits.com or
To Enroll
800-544-3716
NOTE: Be aware that the IRS prohibits you from
Paul Stanislawski, General Manager making contributions to an HSA while enrolled in
Albuquerque, NM Yard Medicare or a Medicare Advantage plan. While
contributions to an HSA aren’t allowed once enrolled
in Medicare, you can still use any existing
HSA balance to pay for eligible health care
expenses now or in future years. Scan the
QR code to learn more.
*With respect to federal taxation only. Contributions,
earnings and distributions may or may not be subject
to state taxation. See a tax professional for more
information on the state tax implications.
Your HSA is an individually-owned account. It is not
administered by BFS, is not an employer-sponsored
39 39 plan, and it is not an ERISA plan.
401(k) www.netbenefits.com
800-835-5095
Who is Eligible? Vesting
All full-time and part-time employees who You are always 100% vested in any
have completed 60 days of employment. contributions you make to your account.
You become vested in employer matching
When Does Participation Begin? contributions on the following schedule:
Employees hired or rehired on or after Years of Service Percent
1/1/2020 are automatically enrolled at a Vested
contribution rate of 1%.
Less than 1 0%
Your Contributions One year 20%
You may contribute up to 75% of your Two years 40%
eligible earnings on a pre-tax basis to the
401(k) plan, up to the annual IRS limit Three years 60%
($19,500 as of this writing). If you are Four years 80%
age 50 or greater, you may be eligible Five or more years 100%
for an additional “catch-up” contribution
($6,500 as of this writing). You specify the
percentage of your earnings you want to Receiving Money From Your Account
contribute. You can change how much The plan is intended to accumulate funds
you are contributing at any time. Contact for your retirement. However, you may
Fidelity Investments directly to start, have access to your funds while you are
change or stop your contribution. still employed by the company under the
following circumstances:
Company Match ; You are age 59-1/2 or greater
You become disabled (as determined
;
In addition to your pre-tax contributions, by the Social Security Administration)
Builders FirstSource helps you save ; You experience a financial hardship,
by making the following matching as defined by the IRS Code
contribution: ; You take a loan against your 401(k)
40 cents for every $1 up to 5% of your account, as allowed under the plan
contribution document
The company does not contribute a match
on catch-up contributions.
Thereza Ramirez, Inventory Control Specialist
Investing Your Account Rancho San Diego, CA Home Center
You direct how your account is invested.
You choose from a variety of funds
offered through Fidelity, including “target
date” funds to align with your estimated
retirement date.
40 40
Picture Gallery
Betty Fulmer, Inside Sales Rep Danny Lozano, Outside Sales Rep Johnnie Taylor, CDL Driver
Columbia, SC Yard Brevard, NC Yard Apex, NC Yard
Valerie Hillman, AP Specialist Joe Cortez, Office Administrator Isaac Hart, Design Tech
Dallas, TX Santa Fe, NM Lumberr Berlin North, NJ Components
Diane Frederic, Sales Support Rep Sean Dick, General Manager Refugio DeLaPaz, Design Tech
Kenai, AK Lumber Santa Fe, NM Lumber Katy, TX Lumber
41
We received so many amazing submissions! Thanks to all for your participation, and if
you haven’t seen your photo in the book, be on the lookout as we will be using the theme
throughout the year!
Sonya Riojas, HR Generalist Steve Hickman, Outside Sales
Mitchel Lapratt, CDL Driver Arlington, TX Rep
Bad Axe, MI Lumber Anchorage, AK Yard
Jose Bravo, Manager Production Jet Haggerty, Leadership & Paul Morrison, Sales Support Rep
Treasure Coast, FL Truss Performance Manager Middletown, NY Millwork
Tacoma, WA
Regina Rowe, Office Admin
Wasilla, AK
42
Required Notices
Important Notice from Builders FirstSource pay prescription drug benefits first, and Medicare
(BFS) and About Your Prescription Drug Cov- will determine its payments second. For more
erage and Medicare information about this issue of what program pays
Please read this notice carefully and keep it where first and what program pays second, see the Plan’s
you can find it. This notice has information about summary plan description or contact Medicare at the
your current prescription drug coverage with telephone number or web address listed herein.
Builders FirstSource (BFS) and about your options
under Medicare’s prescription drug coverage. If you do decide to join a Medicare drug plan and
This information can help you decide whether or drop your current Company-sponsored medical
not you want to join a Medicare drug plan. If you coverage, be aware that you and your dependents
are considering joining, you should compare your will not be able to get this coverage back.
current coverage, including which drugs are covered
at what cost, with the coverage and costs of the When Will You Pay A Higher Premium (Penalty)
plans offering Medicare prescription drug coverage To Join A Medicare Drug Plan?
in your area. Information about where you can get You should also know that if you drop or lose your
help to make decisions about your prescription drug current Company-sponsored medical coverage and
coverage is at the end of this notice. don’t join a Medicare drug plan within 63 continuous
days after your current coverage ends, you may pay
There are two important things you need to know a higher premium (a penalty) to join a Medicare drug
about your current coverage and Medicare’s plan later. If you go 63 continuous days or longer
prescription drug coverage: without creditable prescription drug coverage, your
1. Medicare prescription drug coverage became monthly premium may go up by at least 1% of the
available in 2006 to everyone with Medicare. Medicare base beneficiary premium per month for
You can get this coverage if you join a Medicare every month that you did not have that coverage.
Prescription Drug Plan or join a Medicare For example, if you go nineteen months without
Advantage Plan (like an HMO or PPO) that offers creditable coverage, your premium may consistently
prescription drug coverage. All Medicare drug be at least 19% higher than the Medicare base
plans provide at least a standard level of coverage beneficiary premium. You may have to pay this
set by Medicare. Some plans may also offer more higher premium (a penalty) as long as you have
coverage for a higher monthly premium. Medicare prescription drug coverage. In addition,
2. Builders FirstSource (BFS) has determined that you may have to wait until the following October to
the prescription drug coverage offered under join.
the Company-sponsored medical plan(s) is, on
average for all plan participants, expected to pay For More Information about This Notice or Your
out as much as standard Medicare prescription Current Prescription Drug Coverage
drug coverage pays and is therefore considered Contact the persons listed at the end of these
Creditable Coverage. Because your existing notices for further information. NOTE: You’ll get this
coverage is Creditable Coverage, you can keep notice each year. You will also get it before the next
this coverage and not pay a higher premium (a period you can join a Medicare drug plan, and if the
penalty) if you later decide to join a Medicare drug Company-sponsored medical coverage changes.
plan. You also may request a copy of this notice at any
time.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first For More Information about Your Options under
become eligible for Medicare during a seven-month Medicare Prescription Drug Coverage
initial enrollment period. That period begins three More detailed information about Medicare plans that
months prior to your 65th birthday, includes the offer prescription drug coverage is in the “Medicare
month you turn 65, and continues for the ensuing & You” handbook. You’ll get a copy of the handbook
three months. You may also enroll each year from in the mail every year from Medicare. You may also
October 15th through December 7th. However, if be contacted directly by Medicare drug plans. For
you lose your current creditable prescription drug more information about Medicare prescription drug
coverage, through no fault of your own, you will also coverage:
be eligible for a two (2) month Special Enrollment • Visit www.medicare.gov
Period (SEP) to join a Medicare drug plan. • Call your State Health Insurance Assistance
Program (see the inside back cover of your
What Happens To Your Current Coverage If You copy of the “Medicare & You” handbook for their
Decide to Join A Medicare Drug Plan? telephone number) for personalized help
If you decide to join a Medicare drug plan, your • Call 1-800-MEDICARE (1-800-633-4227). TTY
current coverage in the Company-sponsored users should call 1-877-486-2048
medical plan(s) will not be affected. For most If you have limited income and resources, extra help
persons covered under the Plan, the Plan will paying for Medicare prescription drug coverage is
available. For information about this extra help, visit
43
Social Security on the web at www.socialsecurity. Resources at 1-844-216-9320.
gov, or call them at 1-800-772-1213 (TTY
1-800-325-0778). HIPAA Special Enrollment Rights
If you are declining enrollment for yourself or your
Remember: Keep this Medicare Part D notice. dependents (including your spouse) because
If you decide to join one of the Medicare drug of other health insurance or group health plan
plans, you may be required to provide a copy of coverage, you may be able to later enroll yourself
this notice when you join to show whether or not and your dependents in this plan if you or your
you have maintained creditable coverage and, dependents lose eligibility for that other coverage
therefore, whether or not you are required to pay (or if the employer stops contributing towards your
a higher premium (a penalty). or your dependents’ other coverage).
• Loss of eligibility includes but is not limited to:
Date: October 1, 2019 • Loss of eligibility for coverage as a result
of ceasing to meet the plan’s eligibility
Contact Information requirements (i.e. legal separation, divorce,
Name of Entity/Sender: Builders FirstSource(BFS) cessation of dependent status, death of
Contact—Position/Office: Employee Benefit Dept an employee, termination of employment,
Address: 2001 Bryan Street, Suite 1600 Dallas, TX reduction in the number of hours of
75201 employment);
Phone Number: 1-844-216-9320 • Loss of HMO coverage because the person
no longer resides or works in the HMO service
Women’s Health and Cancer Rights Act area and no other coverage option is available
The Women’s Health and Cancer Rights Act of 1998 through the HMO plan sponsor;
was signed into law on October 21, 1998. The Act • Elimination of the coverage option a person
requires that all group health plans providingmedical was enrolled in, and another option is not
and surgical benefits with respect to a mastectomy offered in its place;
must provide coverage for all of the following: • Failing to return from an FMLA leave of
• Reconstruction of the breast on which a absence; and
mastectomy has been performed • Loss of coverage under Medicaid or the
• Surgery and reconstruction of the other breast to Children’s Health Insurance Program (CHIP).
produce a symmetrical appearance Unless the event giving rise to your special
• Prostheses enrollment right is a loss of coverage under
• Treatment of physical complications of all stages of Medicaid or CHIP, you must request enrollment
mastectomy, including lymphedema within 31 days after your or your dependent’s(s’)
This coverage will be provided in consultation other coverage ends (or after the employer that
with the attending physician and the patient, and sponsors that coverage stops contributing toward
will be subject to the same annual deductibles the coverage).
and coinsurance provisions which apply for the
mastectomy. For deductibles and coinsurance If the event giving rise to your special enrollment
information applicable to the plan in which you right is a loss of coverage under Medicaid or
enroll, please refer to the summary plan description the CHIP, you may request enrollment under
or contact Human Resources at 1-844-216-9320. this plan within 60 days of the date you or your
dependent(s) lose such coverage under Medicaid
HIPAA Privacy and Security or CHIP. Similarly, if you or your dependent(s)
The Health Insurance Portability and Accountability become eligible for a state-granted premium
Act of 1996 deals with how an employer can subsidy towards this plan, you may request
enforce eligibility and enrollment for health care enrollment under this plan within 60 days after the
benefits, as well as ensuring that protected health date Medicaid or CHIP determine that you or the
information which identifies you is kept private. You dependent(s) qualify for the subsidy.
have the right to inspect and copy protected health
information that is maintained by and for the plan for In addition, if you have a new dependent as a
enrollment, payment, claims and case management. result of marriage, birth, adoption, or placement
If you feel that protected health information about for adoption, you may be able to enroll yourself
you is incorrect or incomplete, you may ask your and your dependents. However, you must request
benefits administrator to amend the information. enrollment within 31 days after the marriage, birth,
adoption, or placement for adoption.
The Notice of Privacy Practices has been recently
updated. To request special enrollment or obtain more
For a full copy of the Notice of Privacy Practices, information, contact Human Resources at
describing how protected health information about 1-844-216-9320.
you may be used and disclosed and how you can
get access to the information, contact Human
44
Notice of Health Insurance
Marketplace Coverage Options
(as Required by the Affordable Care Act) coverage. Also, this employer contribution – as well
Why am I receiving this Notice? as your employee contribution to employer-offered
Key parts of the Affordable Care Act became effective coverage – is often excluded from income for federal
in 2014, including the launch of the Health Insurance and state income tax purposes. Your payments for
Marketplace (the “Marketplace”). The Marketplace coverage through the Marketplace are made on an
provides a new way to buy health insurance, separate after-tax basis.
from health coverage that may be offered to you
through your employment with Builders FirstSource Information about health coverage available
and its family of companies. The purpose of this notice through Builders FirstSource
is to provide you some basic information regarding If you decide to complete an application for coverage
the Marketplace. Detailed information regarding the in the Marketplace, you will be asked to provide
Marketplace is available at Healthcare.gov. this information. The information provided below
is numbered to correspond to the Marketplace
What is the Health Insurance Marketplace? application.
The Marketplace is designed to help you find health
insurance that may meet your needs and fit into 3. Employer Name* 4. Employer
your budget. The Marketplace is designed to offer (BFS Company Description) Identification
“one-stop shopping” to find and compare private Number
health insurance options. Open enrollment for health (EIN)
insurance coverage through the Marketplace begins Builders FirstSource – Dallas (Corporate) 75-2794867
on November 1, 2019 and ends December 15,
2019 for coverage starting on January 1, 2020. The Builders FirstSource – Atlantic 52-2080519
Marketplace is separate from health coverage that
may be available to you through Builders FirstSource. Builders FirstSource – Florida 52-2172981
The Marketplace can help you evaluate your coverage Builders FirstSource – Raleigh 56-1454419
options, including your eligibility for coverage through Builders FirstSource – Southeast 57-0618425
the Marketplace and its cost. Visit Healthcare.gov for
more information, including an online application for Builders FirstSource – South Texas 75-2916346
coverage or call 1-800-318-2596.
Builders FirstSource – Arlington/Lewis- 75-2831224
Can I save money on my health insurance ville/Jarrell/Sherman
premiums in the Marketplace?
You may qualify to save money and lower your Builders FirstSource–Texas Installed 75-2896780
monthly premium, but only if Builders FirstSource Sales, LP
does not offer coverage, or offers coverage that
doesn’t meet certain standards. The savings on your ProBuild LLC 20-4011397
premium that you’re eligible for depends on your ProBuild (Spenards Builders Supply Inc) 92-0018778
household income.
ProBuild (Dixieline Fund Control Inc) 57-1168729
Does employer health coverage affect eligibility *If you are unsure which Builders FirstSource company you
for premium savings through the Marketplace? work for, please refer to your paycheck or contact Human
Yes. If you have an offer of health coverage from Resources.
Builders FirstSource that meets certain standards, 5.Employer Address: Builders FirstSource, 2001 Bryan
you will not be eligible for a tax credit through the St, Ste 1600
Marketplace and may wish to enroll in coverage 6.Employer phone number: 1-844-216-9320
through Builders FirstSource. However, you may 7.City: Dallas 8.State: Texas 9.Zip code: 75201
be eligible for a tax credit that lowers your monthly 10.Who can we contact about employee health
premium, or a reduction in certain cost-sharing if coverage at this job?
Builders FirstSource does not offer coverage to Corporate Benefits Department
you at all or does not offer coverage that meets 11. Phone number: 1-844-216-9320
certain standards. If the cost of a plan from Builders 12. Email address: [email protected]
FirstSource that would cover you (and not any Here is some basic information about health coverage
members of your family) is more than 9.5 percent of offered through Builders FirstSource:
your household income (as defined by the IRS) for the • As your employer, we offer a health plan to full-time
year, or if the coverage Builders FirstSource provides employees expected to work at least 30 hours per
does not meet the “minimum value” standard set by week after a 60-day waiting period.
the Affordable Care Act, you may be eligible for a tax • With respect to dependents, we offer coverage to
credit. verifiable spouses and children of eligible employees.
Note: If you purchase a health plan through the • The cost of the employee’s coverage is intended to be
Marketplace instead of accepting health coverage affordable, based on employee earnings.**
offered by your employer, then you will lose the
employer contribution to the employer-offered 14.Does Builders FirstSource offer a health plan that
meets minimum value standards? Yes
45
Premium Assistance Under
Medicaid & CHIP
If you or your children are eligible for www.insurekidsnow.gov to find out how
Medicaid or CHIP and you’re eligible for to apply. If you qualify, ask your state if
health coverage from your employer, your it has a program that might help you pay
state may have a premium assistance the premiums for an employer-sponsored
program that can help pay for coverage, plan.
using funds from their Medicaid or CHIP
programs. If you or your children aren’t If you or your dependents are eligible
eligible for Medicaid or CHIP, you won’t for premium assistance under Medicaid
be eligible for these premium assistance or CHIP, as well as eligible under your
programs but you may be able to buy employer plan, your employer must allow
individual insurance coverage through the you to enroll in your employer plan if you
Health Insurance Marketplace. For more aren’t already enrolled. This is called a
information, visit www.healthcare.gov. “special enrollment” opportunity, and you
must request coverage within 60 days
If you or your dependents are already of being determined eligible for premium
enrolled in Medicaid or CHIP and you assistance. If you have questions about
live in a State listed below, contact your enrolling in your employer plan, contact
State Medicaid or CHIP office to find out if the Department of Labor at www.askebsa.
premium assistance is available. dol.gov or call 1-866-444-EBSA (3272).
If you or your dependents are NOT If you live in one of the following states,
currently enrolled in Medicaid or CHIP, and you may be eligible for assistance paying
you think you or any of your dependents your employer health plan premiums. The
might be eligible for either of these following list of states is current as of July
programs, contact your State Medicaid or 31, 2019. Contact your State for more
CHIP office or dial 1-877-KIDS NOW or information on eligibility.
State Website Contact
Alabama - Medicaid http://myalhipp.com/ 1-855-692-5447
Alaska - Medicaid The AK Health Insurance Premium Payment 1-866-251-4861
Program http://myakhipp.com/ Email:
Medicaid Eligibility: http://dhss.alaska.gov/ CustomerService@
dpa/Pages/medicaid/default.aspx MyAKHIPP.com
Arkansas - Medicaid http://myarhipp.com/ 1-855-MyARHIPP (855-
692-7447)
Colorado – Health Health First Colorado Health First Colorado
First Colorado (CO https://www.healthfirstcolorado.com/ Member Contact Center:
Medicaid Program) CHP+: 1-800-221-3943/ State
& Child Health Plan Colorado.gov/HCPF/Child-Health-Plan-Plus Relay 711
Plus (CHP+) CHP+ Customer Service:
1-800-359-1991/State
Relay 711
Florida - Medicaid http://flmedicaidtplrecovery.com/hipp/ 1-877-357-3268
46
Premium Assistance Under
Medicaid & CHIP
Georgia - Medicaid Website: https://medicaid.georgia.gov/ 687-564-1162 ext
health-insurance-premium-payment-pro- 2131
gram-hipp
Indiana - Medicaid Healthy Indiana Plan for low-income adults Healthy Indiana -
19-64: http://www.in.gov/fssa/hip/ 1-877-438-4479
All other Medicaid: http://www.indianamed- All Other Medicaid -
icaid.com Phone 1-800-403-0864
Iowa - Medicaid http://dhs.iowa.gov/hawk-i 1-800-257-8563
Kansas - Medicaid http://www.kdheks.gov/hcf/ 1-785-296-3512
Kentucky - Medicaid https://chfs.ky.gov 1-800-635-2570
Louisiana - Medicaid http://dhh.louisiana.gov/index.cfm/sub- 1-888-695-2447
home/1/n/331
Maine - Medicaid http://www.maine.gov/dhhs/ofi/public-assis- 1-800-442-6003
tance/index.html TTY: Maine relay 711
Massachusetts - http://www.mass.gov/eohhs/gov/depart- 1-800-862-4840
Medicaid and CHIP ments/masshealth/
Minnesota - Medicaid https://mn.gov/dhs/people-we-serve/seniors/ 1-800-657-3739
health-care/health-care-programs/pro-
grams-and-services/other-insurance.jsp
Missouri - Medicaid http://www.dss.mo.gov/mhd/participants/pag- 573-751-2005
es/hipp.htm
Montana - Medicaid http://dphhs.mt.gov/MontanaHealthcarePro- 1-800-694-3084
grams/HIPP
Nebraska - Medicaid http://www.ACCESSNebraska.ne.gov (855) 632-7633
Lincoln: (402) 473-7000
Omaha: (402) 595-1178
Nevada - Medicaid Medicaid http://dhcfp.nv.gov Medicaid: 1-800-992-
0900
New Hampshire - https://www.dhhs.nh.gov/oii/hipp.htm 603-271-5218
Medicaid Toll free number for the
HIPP program: 1-800-
852-3345, ext 5218
New Jersey - Medicaid http://www.state.nj.us/humanser- Medicaid 609-631-
Medicaid and CHIP vices/dmahs/clients/medicaid/ 2392
CHIP http://www.njfamilycare.org/index. CHIP 1-800-701-0710
html
New York - Medicaid https://www.health.ny.gov/health_care/ 1-800-541-2831
medicaid/
North Carolina - https://medicaid.ncdhhs.gov/ 919-855-4100
Medicaid
47
North Dakota - http://www.nd.gov/dhs/services/medicals- 1-844-854-4825
Medicaid erv/medicaid/
Oklahoma - Medicaid http://www.insureoklahoma.org 1-888-365-3742
and CHIP
Oregon - Medicaid http://healthcare.oregon.gov/Pages/index. 1-800-699-9075
aspx
http://www.oregonhealthcare.gov/index-es.
html
Pennsylvania - http://www.dhs.pa.gov/provider/medicalas- 1-800-692-7462
Medicaid sistance/healthinsurancepremiumpaymen-
thippprogram/index.htm
Rhode Island - http://www.eohhs.ri.gov/ Phone: 855-697-4347,
Medicaid and CHIP or 401-462-0311 (Di-
rect RIte Share Line)
South Carolina - https://www.scdhhs.gov 1-888-549-0820
Medicaid
South Dakota - http://dss.sd.gov 1-888-828-0059
Medicaid
Texas - Medicaid http://gethipptexas.com/ 1-800-440-0493
Utah - Medicaid and Medicaid https://medicaid.utah.gov/ 1-877-543-7669
CHIP CHIP http://health.utah.gov/chip
Vermont - Medicaid http://www.greenmountaincare.org/ 1-800-250-8427
Virginia - Medicaid Medicaid http://www.coverva.org/pro- Medicaid 1-800-432-
and CHIP grams_premium_assistance.cfm 5924
CHIP http://www.coverva.org/programs_ CHIP 1-855-242-8282
premium_assistance.cfm
Washington - http://www.hca.wa.gov/ 1-800-562-3022 ext.
Medicaid 15473
West Virginia - http://mywvhipp.com/ Toll-free 1-855-My-
Medicaid WVHIPP (1-855-699-
8447)
Wisconsin - Medicaid https://www.dhs.wisconsin.gov/publications/ 1-800-362-3002
and CHIP p1/p10095.pdf
Wyoming - Medicaid https://wyequalitycare.acs-inc.com/ 307-777-7531
48
Contact Guide
Fidelity 401(k) 1-800-835- www.netbenefits.com
Fidelity 5095
Sun Life Financial - Gap 1-800-648- www.slfserviceresources.
Policy 8624 com
Claims Address: Claims Fax: Claims email: claimsmail@
Fidelity Security Life Ins 1-816-968- ftj.com
Co 0575
3130 Broadway,
P.O. Box 418131
Kansas City, MO
64141-8131
Blue Cross Blue Shield of 800-521-2227 www.bcbstx.com
Texas
Claims Address: Check your ID card for group
P.O. Box 660044 and member ID number.
Dallas, TX 75266-0044
MDLive 888-680-8646
24/7 Nurseline 800-581-0368
Special Beginnings 888-421-7781
Fitness Program 888-762-2583
Provider Finder 800-810-BLUE
(2583)
Naturally Slim www.naturallyslim.com/bfs
[email protected]
CVS/Caremark Rx 1-844-431- www.caremark.com
Standard 4881
Mail Order Claims Address: Check your ID card for group
P.O. Box 94467 and
Palatine, IL 60094-4467 member ID number.
RX Reimbursement Claims
Address:
P.O. Box 52136
Phoenix, AZ
85072-2136
You must notify the Benefits Department within 31 days of a family status
change and provide the proper documentation to add or drop coverage.
These include marriage, divorce, birth, adoption, loss or gain of other
coverage due to dependent’s job status change or annual enrollment.
49
The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.
Discover the best professional documents and content resources in AnyFlip Document Base.
Search