2021
Team Member Benefit Guide
Learn about your Benefits options including:
• FREE preventive care when enrolled in a BFS Medical Plan
• Medical, dental, and vision plan choices
• Virtual visits with doctors 24/7
• Resources to help you maximize your benefits
• FREE tools to help you lose weight, end type 2 diabetes, quit smoking,
end joint pain, and more!
Contact 844-216-9320 or [email protected] for information about enrollment, effective
dates, and any benefits questions.
Para una guia en Espanol: 844-216-9320 o [email protected]
Welcome
Have a Smartphone?
This Benefit Guide is equipped with Eliana Osorio, Production Coordinator
mobile-friendly barcodes commonly Treasure Coast, FL
referred to as “Quick Response” or
QR codes. Scanning these codes
will take you to a new place on
your phone. They might show you a
website, video, or article. They can
take you anywhere, you just have to
scan them.
So How do I Scan Them?
Your phone may be able to read
them from within its camera app -
try taking a picture of one and see
what happens. If it doesn’t pop up
a link, then you’ll need one of the
many free QR Reader apps available
for smartphones or tablets. After the
download, just open the app and
follow the directions to scan the
QR code. The app will read it and
immediately take you to that code’s
content.
Hire Date Range Benefit Effective Date
Try it now on our benefits 10/4/20 - 11/3/20 1/1/2021
video library!
Scan the QR code to access 11/4/20 - 12/4/20 2/1/2021
quick informational videos about 12/5/20 - 1/1/21 3/1/2021
our benefits plans.
1/2 - 2/1/21 4/1/2021
Open Enrollment for 2021 is passive 2/2 - 3/3/21 5/1/2021
- meaning you do not have to enroll 3/4 - 4/3/21 6/1/2021
to maintain your benefits - EXCEPT 4/4 - 5/3/21 7/1/2021
in the case of any Flexible Spending 5/4 - 6/3/21 8/1/2021
Account. You must re-enroll in these
each year. 6/4 - 7/4/21 9/1/2021
7/5 - 8/3/21 10/1/2021
We have featured our Team Members 8/4 - 9/3/21 11/1/2021
and their families throughout this
guide! See if your picture made 9/4 - 10/3/21 12/1/2021
it, or you might spot a coworker’s 10/4 - 11/3/21 1/1/2022
submission! 11/4 - 12/4/21 2/1/2022
12/5 - 1/1/22 3/1/2022
Photos are identified by the Team
Member who submitted them. Your enrollment window opens 2 to 4 weeks
before your Benefits Effective Date. Your
benefit premiums will process on the first
Featured on the cover is a submission paycheck of your month of eligibility. Additional
from Charles Olmos, a Design Tech I at premiums will be recouped retroactively to the
1 Albuquerque, NM Components. coverage effective date in no less than two pay
periods – so it pays to enroll early!
Eliana Osorio, Production Coordinator
Treasure Coast, FL
Bob Carroll, Manager Credit
Farmingdale, NY
Table of Contents
LEARN YOUR WEALTH
3 What’s New for 2021 Wealth Protection
3 Preparing to Enroll 35 Short-Term Disability
4 Mid Year Changes 37 Long-Term Disability
5 Benefits Eligibility 39 Survivor Benefits
7 Frequently Asked Questions
Wealth Building
41 Health FSA / Limited Purpose FSA
YOUR HEALTH 42 Dependent Daycare FSA
9 Employee Assistance Program 43 Health Savings Account
10 Tobacco Cessation Program 44 401(k) Savings Plan
11 Virta - for Type 2 Diabetics
12 Naturally Slim Program 45 PICTURE GALLERY
13 Hinge Health for Chronic Pain
14 Benefits Value Advisor 47 REQUIRED NOTICES
15 Medical Plan Choices 53 CONTACT GUIDE
19 Virtual Visits/MD Live
20 Mental Health Resources
21 Where to Go For Care
23 Blue Care Connection
24 Member Rewards
25 Medical Plan Rates
27 Pharmacy Benefits
29 Medical Gap Insurance
31 Vision Plans 2
33 Dental Plans
What’s New for 2021
Medical
• Medical plan premiums for both the Standard PPO Plan and the Consumer HDHP
Plan will increase slightly.
• The Deductible and the Out of Pocket Limits have changed in the Consumer HDHP,
please see page 17 for details.
Dental
Dental premiums are decreasing in 2021. See page 34 for more information.
401(k)
New in 2021! An after-tax Roth contribution feature will be added to the 401(k) plan.
Detailed information to be provided near year end 2020. See page 44.
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 by clicking here 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
Astrid Morales, Manager Office Admin a request on your behalf.
3
3 Tampa, FL
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 2021
for coverage starting January 1, 2022.
Submit your family change online in the Dayforce System at https://www.
dayforcehcm.com. To see our Mid-Year Qualifying Events Chart providing
detailed guidance, please click here or scan the QR Code.
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 have a new
child - whether by
birth or adoption.
You get married, Your spouse or
divorced, or legally dependent gains or
separated. loses coverage.
Lester Price Rocibel Armengolt Dan Roach
Safety Coordinator Office Administrator Project Manager
Valley Center, Kansas Treasure Coast, FL SoCal Home Center
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!
4
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 2021 Annual Enrollment (November yourself, you may also elect coverage for your
9-20, 2020): Coverage will be effective on eligible dependents.
January 1, 2021. Your eligible dependents include:
; New hire employee: Coverage will ; Your legal spouse
be effective on the first of the month ; Your children up to age 26 (25 years old
coincident with or following 60 days of full- or younger) – including
time employment (e.g., if you start working ; Natural children (born to you)
on January 15, your benefits eligibility ; Stepchildren
date is April 1). A notice of eligibility will ; Adopted children
be mailed to your home address. You ; Children whose legal guardianship
must enroll within 31 days of your benefit has been granted to you by the state
eligibility date. (See p.1 of this guide for ; Your unmarried grandchild under the
benefits eligibility dates.) age of 26 who is your dependent for
; A newly-eligible employee due to a federal income tax purposes
change in status from part-time to full- ; Your unmarried child age 26 and older
time: Coverage will be effective on the first who depends solely on you for support
of the month following or coincident with because of mental or physical disability
60 days of full-time employment based on where the disability arose before age 26
your status date change. (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.
Click here or scan the QR code for the list of
acceptable documents needed for dependent
Yomara Villanueva, HR Generalist verification.
5
5 Houston, TX Windows
Regina Rowe, Office Adminstrator III
Wasilla, AK
What if my spouse or child and I both
work for the company?
You may each enroll in the medical, dental,
What is an offer of qualifying and vision plans individually as “Employee
coverage by an employer?
Your spouse is offered qualifying coverage Only”, or you, or your spouse may enroll
if the medical plan offered is 1. “Affordable,” as “Employee + Spouse” (or “Employee +
meaning your spouse’s premium for the cost Family”). You cannot be enrolled as both
of the employee’s coverage does not exceed an employee and a dependent. However,
9.78% of his/her income and 2. provides children of parents who both work for the
“minimum value,” meaning the plan pays at company can be covered by only one parent’s
least 60% of the total allowed costs provided plan. You cannot elect spouse life, or spouse
under the plan. AD&D insurance if your spouse is also a
regular, full time employee of the company.
How will my spouse know if his/
her employer’s offer of coverage is
Qualifying coverage? Working Spouse Exclusion from
If your spouse’s employer offers health
coverage, the employer is required by Medical Coverage
law to provide employees with a notice An employee’s spouse who has access to
indicating whether the employer’s coverage affordable health care that provides minimum
meets affordability standards. Consult your value (“Qualifying Coverage”, defined by
spouse’s employer if you have questions the Affordable Care Act) through another
about your spouse’s health plan. employer is not eligible for enrollment in
a Builders FirstSource medical plan. This
Enrollment of your spouse in a medical plan exclusion applies only to enrollment of your
serves as certification that your spouse does spouse in the medical plan. You may freely
not have access to Qualifying Coverage enroll your spouse in other lines of coverage
through his/her employer. such as dental or vision.
6
Frequently Asked Questions
How do I find a provider? Know your BCBS Provider Network!
For a medical provider: Resident State BCBS Provider Network
http://www.bcbstx.com
Current Member: Log in to Blue Access for Colorado CO Pathway
Members (BAM) at www.bcbstx.com or on the Florida Network Blue
BCBSTX mobile app. First-time users will need Georgia Blue Open Access POS
to register using the member ID reflected on
your ID card. Once logged into BAM, select Maryland BlueChoice Advantage Open
Provider Finder and perform your search. When Access
you are logged into BAM under your member ID, Tennessee Network S
the system automatically brings up the correct
BCBS network that applies to you. Wisconsin Blue Preferred POS
To Search as a Guest: Go to www.bcbstx.com All Other States Blue Choice PPO
and select Find a Doctor or Hospital.
• Click ‘Search as a Guest’ .
• On the next page, click ‘Search In-Network Or call BCBS Provider Finder at 1-800-810-
Providers’ . 2583, Monday to Friday between 8 a.m. and
• In the drop-down box ‘How do you get 6 p.m. CT.
insurance?’, select ‘Through my employer or For a MetLife dentist go to www.metlife.com
my spouse’s employer’ .
• In the drop-down box ‘Select the type of care • Click “I want to find a MetLife: Dentist”
Enter Zip Code
•
you are looking for’, select ‘Medical’ .
• Input in the next drop-down box the state • Select your Network: PDP Plus
Click “Submit”
•
where you live.
• In the drop-down box for ‘Select Plan/ For a vision provider go to www.eyemed.com
Network’, input the correct provider network • Click “Login” > “Member”
selection from the table below. • Register using the last 4 of your SSN
• Input the remaining fields to complete the if you do not have a username and
search. password
• Click “Locate a Provider”
Do I need to enroll in a pharmacy Plan?
No. Your pharmacy benefit is included in
your medical plan election; however, you will
receive a separate ID card for prescriptions.
How do I get benefit plan ID cards?
Your medical, prescription drug, dental and
vision plan providers will mail ID cards to
your home address. If the Company has your
correct address on file, you should receive ID
cards within 15 business days of enrolling. If
you are needing a temporary ID card, please
register yourself on the BCBS, Caremark,
MetLife, and/or Eyemed websites and an
option to view your card will be available. You
can also contact the Benefits Department at
[email protected] or call 844-216-9320.
Shawn Smith, Driver
7 7 Verona, VA
What if my spouse or child and I both work I am turning 65 soon. What will happen to
for the company? my current benefits with the company?
You may each enroll in the medical, dental Your current benefits will continue to stay
and vision plans individually as “Employee active. No action is required to maintain
Only,” OR you, or your spouse, may enroll coverage. However, if you want to drop
as “Employee + Spouse” (or Employee + your medical plan due to gaining coverage
Family”). You cannot be enrolled both as an through Medicare, you will just need to
employee and as a dependent. However, follow the instructions to submit a life event
children of parents who both work for the through Dayforce. Please review the Mid Year
company can be covered by only one parent’s Changes section on page 4.
plan. You cannot elect spouse life or AD&D
insurance if your spouse is also a regular, full- I have a question about my claim/benefit
time employee of the company. deductions on my pay checks/leave of ab-
sence/Dayforce benefits enrollment, etc.
What if I need to add a dependent or make Who do I contact?
changes to coverage after I enroll? The Benefits Department can be your first
Due to limitations required by law, generally point of contact to help direct you to the best
employees cannot make mid-year election resource. You can email [email protected] or
changes without a qualifying family status call 844-216-9320 (7am-6pm CST).
change. Employees have 31 days from the
effective date of a qualifying family status
change to make changes to their benefits.
See Mid-Year Changes on page 4 for more
information on qualifying family status
changes.
I enrolled in Medicare. I also have medical
coverage with the company. How does that
work?
The coverage through the company will pay
primary and Medicare pays secondary. This
means that your company coverage will pay
first on health care claims, and Medicare
insurance pays second on remaining costs.
The “PPO in a suitcase” logo on
the front of your BCBS medical
ID card means you are part of
the BlueCard program. This
means you and your covered
dependents may use Blue Cross and Blue
Shield network providers throughout the
United States, even while traveling or away
from your home state.
Crystal Wright,
Supervisor Accounts Payable 8 8
Dallas, TX
Employee Assistance
The EAP is available even to Team Legal Support & Resources
Members not on a BFS Medical Plan. Talk to attorneys by phone. If you require
representation, you’ll be referred to a qualified
Employee Assistance Program (EAP) can attorney in your area for a free 30-minute
help you manage the daily stress of work, consultation with a 25 percent reduction in
home and family life. Employees and customary legal fees thereafter. Call about:
immediate family members can use the EAP ; Divorce and family law
free of charge. Guidance Resources offers ; Debt and bankruptcy
face-to-face consultations, over-the-phone ; Landlord/tenant issues
consultations and online resources. ; Real estate transactions
; Civil and criminal actions
The EAP can help with:
Work-Life Solutions
Confidential Counseling Work-Life specialists will do the research
No-cost short-term counseling services for you, providing qualified referrals and
available for relationship and other personal customized resources for:
issues you and your family may face. ; Child and elder care
Trained clinical counselors are available ; Pet care
telephonically or get a referral for up to five ; Moving and relocation
in-person counseling sessions per family ; Home repair
member, per year for: ; Estate Planning, Wills
; Stress, anxiety and depression
; Relationship/marital conflicts GuidanceResources® Online
; Problems with children GuidanceResources Online is your one stop
; Grief and loss for expert information on the issues that
; Substance abuse matter most to you: relationships, work,
school, children, wellness, legal, financial, free
Financial Information & Resources time and more.
Speak by phone with Certified Public
Accountants and Certified Financial
Planners on a wide range of financial 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” .
9 Frances Daniels, Financial Analyst Senior
Greenville, SC
Tobacco Cessation
Tobacco & Nicotine Cessation Program
Employees and/or spouses who are enrolled The program uses the 4 Essential Practices to
in a Company-sponsored medical plan and Quit For Life:
paying a tobacco surcharge will have the ; Quit At Your Own Pace – Quit on your own
surcharge removed upon completion of five terms, but get the help you need, when you
Quit Calls with the program. need it.
; Conquer Your Urges to Smoke - Gain the
The Quit for Life ® Program is the nation’s skills you need to control cravings, urges and
leading tobacco and nicotine cessation situations involving alcohol.
program. It can assist you in overcoming ; Use Medications So They Really Work -
physical, psychological and behavioral Learn how to supercharge your quit attempt
addictions to tobacco and/or nicotine through with the proper use of nicotine substitutes or
coaching, a customized quitting plan and a medications.
supportive online community. ; Don’t Just Quit, Become a Non-Tobacco
User – Once you’ve stopped using tobacco,
Expert Quit Coaches® help participants gain learn to never again have that “first” cigarette.
the knowledge, skills and behavioral strategies
to quit for life. Participants have unlimited You or a loved one could be the next person we
access to phone- and web-based coaching as help quit tobacco.
well as to Web Coach®, an online community
for e-learning and social support. Participants The program is free, confidential, and it works!
also receive a workbook that helps guide them
through the 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.
Kim Bishop, Conversion Analyst
Dallas Virtual
The average cost of
cigarettes for a year is
more than $2,000!
10
Virta - For Type 2 Diabetics
Reversing type 2 diabetes with Virta!
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!
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 a Builders FirstSource health plan. This
benefit is offered to those with type 2 diabetes.
Tonya Doepel, Office Administrator
Virta can help you: Tampa, FL
; 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
From real BFS Team Members:
“I have lost 27 pounds...I no longer take any diabetic
meds (I was on 3)! I have learned so much and the
support system is awesome too!”
“I have had type 2 diabetes for 10 years and was
never able to reduce the sugar levels below 100, and
frankly even with medication I never thought it was
possible. I guess I was totally wrong, this program
helps me stay focused in all I have to do to achieve
results I never believed were possible.”
Apply today at
11 https://www.virtahealth.com/bfs
Naturally Slim www.naturallyslim.com/BFS
Ever wonder how some people can eat Who’s eligible?
whatever they want and not gain weight? Employees, spouses, and adult
We’ll show you how it’s done. dependents age 18 and over who are
covered on the Builders FirstSource
Naturally Slim® is a common-sense, online medical plan are eligible to participate in
weight loss program based on Eatology™, the the program.
study of when, why and how we eat. Unlike diets,
which rely on your willpower and ‘eat this, not Is there a cost?
that’ advice, Naturally Slim teaches you simple, For eligible participants, the Builders
repeatable skills to help you lose weight and keep FirstSource medical plan pays 100% of
it off in the real world, while still eating the foods the program with no out of pocket cost
you love! to the participant. Program fees will be
submitted to BCBS for processing.
Here’s how Naturally Slim works:
Instead of making you count points, track calories From real BFS Participants:
or change your diet to kale smoothies, we use “It has positively affected my thyroid
a science-based approach based on the eating condition. Thank you BFS for allowing the
patterns that people who don’t struggle with their opportunity to better ourselves.”
weight use naturally. During the initial 10 weeks
of the program, you’ll log-in to your Naturally Slim “I cannot believe this. I have lost 15
dashboard to learn tips like: pounds in 3 weeks with NO effort. I
; Ways to enjoy your favorite foods without have kicked my sugary drink habit. I am
going overboard sleeping better and have energy that I
; How to manage the differences between didn’t know existed. I am so grateful for
appetite and hunger this program.”
; How to keep thirst from hijacking your
weight loss “My wife said that I don’t snore like I used
; The reasons we eat, many of which have to. I’m not as loud and I snore less... After
nothing to do with hunger 11 weeks I have lost 18 pounds and am
; How to stop eating around emotions like looking forward to losing more.”
stress, anger and depression
; How to sleep better, become more physically
active, reduce stress and more!
To learn more and sign
up for the next session,
visit
naturallyslim.com/BFS.
Justin Pratt, DPM Customer Experience 12 12
Dallas, TX
Hinge Health for Chronic Pain
Conquer back, knee, shoulder, neck or hip pain without drugs or surgery!
Hinge Health is an innovative digital program How will this program help me?
to help conquer chronic back, knee, shoulder, On average, users report 60% pain reduction
neck, or hip pain – without drugs or surgery. amongst people who complete their 3x a
Best of all, this new benefit is available at no week of exercise therapy. The program guides
cost to Team Members and family members you in an asy-to-use exercise therapy that
on the BFS medical plan. strengthens muscles to bring greater support
to joints, thus alleviating pain.
The program only takes 45 minutes per week,
and the average participant reports 60% pain What is a health coach?
reduction by the end of the program. A health coach is an accountability partner.
They will work 1:1 with you throughout the
Enroll today and you’ll receive: program to help create and stick with your
• A free tablet computer and wearable sensors individual goals. You will have a monthly call
(sensors are only worn while stretching) with your health coach, and they will check-in
• Unlimited access to a personal health coach with you each week.
• Exercise therapy tailored to your condition
and schedule Can I do more than one program at a time?
Unfortunately, you are unable to do multiple
Once enrolled, you’ll receive the Hinge programs simultaneously. We recommend
Health Welcome Kit, which includes a tablet selecting the condition you are currently
computer and wearable motion sensors that’ll struggling with the most. Once you complete
guide you through the exercises. You’ll also be the first 12-week program, you are welcome to
connected with your personal health coach participate in another program.
who will tailor the program to your needs and
be with you every step of the way. What if my doctor told me I can’t do specific
movements?
What are the expectations of the program? The program is designed to meet you where
Complete 3 days/week of exercise therapy you’re at. We provide modifications and
sessions that take about 15 minutes. This can education on how to pace during activities so
be adjusted or modified based on your needs. you are set up to succeed.
What happens to the tablet and sensors
Holly Wymss, Project Manager after program completion?
SoCal Home Center Admin They’re yours to keep!
From real BFS participants:
“Today’s a good day! I looked forward to
stretching because I have reaped the benefits...I
can postpone surgery and carry on with life!”
“We went to the caverns and went down 180
feet underground and back up and I am not
sore! Prior to Hinge I would not have been able
to move for days.”
Get started today at
hingehealth.com/bfs!
13
13
Benefits Value Advisor
BVAs make it easier to use your health
plan, while helping you save time and
money. They are available 24 hours a day,
seven days a week to explain your benefits
and provide guidance on how to use them.
BVAs will also help you:
• Find a doctor or facility
• Get cost estimates for procedures and
services
• Schedule appointments
• Set up preauthorizations (if needed)
Get Informed on Cost Estimates
The same procedure performed in the
same area by different providers can
vary greatly in cost. A BVA will help you
pick the right provider for you!
Chelsea Parker, Office Administrator
Tacoma, WA
14
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
your annual deductible.
pocket maximum.
2
0%
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 pays maximum, the plan
for the remainder of the 100% care for the remainder 100%
100% for eligible care
pays 100% for eligible
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 pay in your HSA to help pay your out-of-
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 something
You take several generic 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).
15
Earl Wilson & Bobby Arthur, Load Builders
Medical Plan Choices El Cajon, CA
Consumer HDHP Plan
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. 24 for more
information.)
Medical ID Cards for 2021
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.
16 16
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
Specialist $50 20% of Out of Pocket Maximum,
then 0%.
Deductible (by coverage tier) You pay: You pay:
Employee Only $2,250 $2,500
Employee + 1 Dependent $3,375 $5,000
Employee + 2 or more $4,500 $5,000
Dependents
Coinsurance (% you pay after 30% 20%
Deductible)
Out of Pocket Maximum*
(by coverage tier)
Employee Only $6,350 $6,500
Employee and 1 Dependent $10,475 (limit of $6,350/person) $13,000 (limit of $6,500 per person)
Employee and 2+ Dependents $12,700 (limit of $6,350/person) $13,000 (limit of $6,500 per person)
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.
17
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.)
Deductibles, Coinsurance, Out of Pocket Maximums explained –
In addition to your medical plan paycheck deductions, your deductible is the amount of money
you have to pay out-of-pocket, in a calendar year, for covered medical expenses before your
insurance plan starts helping with costs, with the exception of the PPO plan established
co-pays.
The Coinsurance percentage is the amount the insurance company pays after you meet this
calendar year deductible, and before you satisfy your Out-of-Pocket Maximum.
The deductible does not represent the maximum amount you have to pay before insurance
pays, but represents the total amount you must pay before the coinsurance is applied.
The Out-of-Pocket Maximum is the amount you pay for medical care during a calendar
year. This maximum includes the total expenses you paid for your medical care including
your deductible, coinsurance and copayments, up to the limits of the plan you choose. The
PPO plan’s maximum out of pocket is $6,350 per covered person, up to the family maximums
of $10,475 (for Employee plus one dependent) and $12,700 (for Employee plus two or more
dependents). When one family member satisfies his/her individual out of pocket maximum of
$6,350, the remaining family out of pocket maximum is satisfied by the other family member(s)
either individually or collectively.
Example # 1 – Employee + 2 dependents
John, Mary and Susie are covered under the PPO plan.
John meets his $6,350 after having a surgery. The plan would then cover his services 100%
of the allowance as long as the services are rendered by an in-network provider and the
services are eligible.
Mary has services and meets $3,000 towards her in-network out of pocket maximum, then
Susie would only have to satisfy another $3,350 towards the overall family out of pocket
maximum of $12,700.
The plan would show the family out of pocket maximum is met and cover in-network
eligible services 100% of the allowance for the rest of the benefit period because the
family met their combined cost of services of $12,700
Example # 2 - Employee + 2 Dependents
John and Mary meet their $6,350 each, if Susie has services she would not have to satisfy
anything additional since Mary and John met the total of $12,700.
18
Virtual Visits / MDLive
With your Virtual Visits MDLive is available 24/7/365!
benefit, provided by Blue MDLive is great for:
Cross and Blue Shield of ; Cold & flu symptoms
Texas (BCBSTX) and powered ; Ear infections
by MDLIVE, the doctor is ; Allergies
in 24/7/365. You can see a ; Pink eye
doctor or behavioral health specialist without ; Short term prescription refills and more!
leaving the comfort of your own home.
The copay is $10 per consultation for the
Virtual Visits allows you to consult an Standard Plan PPO members. The consultation
independently contracted, board-certified fee for Consumer Plan members will be $44
doctor or therapist for non-emergency until the plan deductible is met; then 20%.
situations by phone, mobile app or online Payment is due at the end of the consult by
video anytime, anywhere. Speak to a doctor credit or debit card. You may also use your FSA
or schedule an appointment at a time that or HSA card to pay for the service.
works best for you.
Contact MDLive at 888-680-8646, at www.
mdlive.com, or through their app. A doctor
will contact you in about 10 minutes. The
doctor can send a prescription to your
pharmacy electronically.
19 Leslie Woolery, Office Administrator Joann Rentz, Credit Analyst
19
Longmont, CO Cherry Point, SC
Mental Health Resources
We have two great options for additional mental health resources. Please review and find
the one that is best for you if you need help with stress, anxiety, depression, relationship/
marital conflicts, problems with children, grief and loss, substance abuse, or if you just
need someone to listen.
MDLive Behavioral Health ComPsych EAP
This option is available to Team Members This option is available to all Team Members
on either BFS Medical Plan. - even those not on a BFS Medical Plan.
The copay is $10 per consultation for the The EAP offers someone to talk to 24/7 and
Standard Plan PPO members. The consultation trained clinical counselors are available
fee for Consumer Plan members will be $44 telephonically or you can get a referral for
until the plan deductible is met; then 20%. up to five in-person counseling sessions per
Payment is due at the end of the consult by family member, per year.
credit or debit card. You may also use your FSA
or HSA card to pay for the service. Call the toll-free EAP line 24-hours a day,
7 days a week at 1-888-327-7401, or visit
Contact MDLive at 888-680-8646, at www. them online at www.guidanceresources.
mdlive.com, or through their app. For
.
behavioral health, an appointment must com using the company ID “BFSEAP”
be made, but there are often appointments
available very soon.
Lori Budd, Regional Manager Cedit Mary Dobrowolski,
Arlington, TX Sales Support 20
20
Petoskey, MI
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
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
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.
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.
2 Vitals Annual Wait Time Report, 2017. 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
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.
21 Monique Adenaike, HR Assistant James Varnedore, Driver
21
Dallas, TX Roanoke Rapids, NC
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. Nurses are
Confused About Where to Go for Care? available at 800-581-0393, 24 hours a day,
seven days a week, to answer your health
SmartER Care options may save you money. questions.
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 Urgent Care Center or Freestanding ER
to use each type of care. Knowing the Difference Can Save You
• 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 Money!
for in-network providers in your area at bcbstx.com or by calling the Customer Service number on your Hospital ER Urgent care centers and freestanding ERs can
member ID card. • Open 24 hours, seven • Could be transferred be hard to tell apart. Freestanding ERs often
to a hospital-based ER
days a week depending on medical look a lot like urgent care centers, but costs
• Average wait time is situation may be higher. A visit to a freestanding ER
four hours, seven • Services do not
Urgent Care minutes 4 include trauma care often results in medical bills that may be 10
Center • If you receive care • Often freestanding ERs times the rate charged by urgent care centers
Virtual Visits Doctor’s Office Retail Health • Generally open evenings, from an out-of-network are out-of-network. If for the same services. Here are some ways to
provider, you may have
you receive care from an
know if you are at a freestanding ER:
• Available 24 hours a day, seven days • Office hours vary Clinic weekends and holidays to pay more. Providers out-of-network provider, • Look like urgent care centers, but have
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 the word “Emergency” in their name or
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 on the building.
counselor, therapist or psychiatrist • Doctor-to-patient • Usually lower out-of-pocket your health plan’s fee they may charge you more • Are open 24 hours a day, seven days a
cost than urgent care
whether you’re at home or traveling relationship established • Average wait time is schedule. than your health plan’s fee week.
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.
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 not attached to and may not be
MDLIVE.com/bcbstx or using the convenient, low-cost and/or telephone doctors and facility charge a facility fee that affiliated with a hospital.
®
MDLIVE mobile app 1 • Average wait time is treatment for minor check-in urgent care centers do • Are subject to the same ER member
medical problems
2
• Medical: Average wait time is less 18 minutes not. You may receive share which may include a copay,
than 20 minutes. other bills for each doctor
5
• Behavioral Health: Can be scheduled you see. coinsurance and applicable deductible.
24 hours a day, but consultations are
conducted by appointment. Find urgent care centers near you by
$ $ $ $ $ $ $ $ $ $ $ $ texting URGENTTX to 33633.
If you need emergency care, call 911 or seek help from any doctor or hospital immediately.
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.
KTamar Davis, Sawyer Jenny Jung, Compensation Analyst
Salt Lake City, UT Denver, CO 22 22
Blue Care Connection
Fitness Program
Blue Access for Members (BAM™) Members and covered dependents (age
Log on to BAM at www.bcbstx.com from your 18+) are eligible for access to over 8,500
smartphone, computer or tablet to access a fitness centers nationwide for $25 to sign
provider directory, request an ID card or check up, $25 per month (per person) with NO
your claims. If you do not have internet access, contract. 1-888-762-2583
contact BCBS
at the toll-free number on the back of your ID Blue Points
card. Working with Well On Target can help you
earn points that you can redeem for gift
Blue Care Advisors Condition Support cards and products! All you have to do is
Clinical professionals are available to help maintain you health and log on to BAM at
you manage chronic health conditions www.bcbstx.com and select Well on Target
such as asthma, COPD, diabetes, heart to start earning points by participating in
disease, low back pain, etc. Participation in eligible fitness activities! This free program
condition support is voluntary and completely will help you stay accountable to your
confidential. Log on to BAM™ to learn more. health while 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 Access to registered nurses who can advise
information, tips and you on self-care or refer you to a provider.
stories on a variety of 1-800-581-0368
health and wellness topics, offer support and talk
about ways to live healthier. Log on to BAM™ to
learn more.
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.
A voluntary program for expectant mothers
1-888-721-7781
Dana Kautz, AP Specialist
23 McCall, ID
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. 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.
2. GO
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 Isabel Pinon, Design Tech
home. Treasure Coast, FL
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
Dana Kautz, AP Specialist Provider Finder.
McCall, ID 24
Medical Plans Rates
Bi-Weekly Payroll Deductions - PPO (Standard Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 48.95 54.11 56.35 67.84 82.27
Employee + Spouse 137.48 155.63 162.80 197.79 254.23
Employee + Children 113.72 128.83 134.38 151.34 175.16
Employee + Family 168.13 188.10 205.19 229.62 291.92
Weekly Employee Payroll Deductions - PPO (Standard Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 24.47 27.05 28.17 33.92 41.13
Employee + Spouse 68.74 77.81 81.40 98.90 127.11
Employee + Children 56.86 64.41 67.19 75.67 87.58
Employee + Family 84.06 94.05 102.59 114.81 145.96
Bi-Weekly Payroll Deductions - HSA Eligible HDHP (Consumer Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 35.07 40.22 42.46 53.95 68.39
Employee + Spouse 108.30 126.46 133.63 168.61 225.05
Employee + Children 86.77 101.88 107.43 124.39 148.21
Employee + Family 124.64 144.62 161.70 186.14 248.44
Weekly Payroll Deductions - HSA Eligible HDHP (Consumer Plan)
Earning < $25k $25-39.9k $40-69.9k $70-99.9k $100k+
Employee Only 17.54 20.11 21.23 26.97 34.19
Employee + Spouse 54.15 63.23 66.81 84.30 112.52
Employee + Children 43.38 50.94 53.72 62.19 74.10
Employee + Family 62.32 72.31 80.85 93.07 124.22
Tobacco users pay an additional $23.08 biweekly or $11.54 weekly (applies to EACH of the
employee and spouse, if enrolled). Want to remove the Tobacco surcharge? Check out page 10.
Scott S. Baker,Component Sales Rep
25 New Hampton, IA
25
Medical Plans Rates Maria Santiago Caban, Office Administrator
Tampa, FL
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 Team Members – Annualized base hourly rate of pay, not counting overtime
• Salaried Team Members – Base annual rate of pay, not counting bonuses
• Variable Pay & Commission-based Team Members – Actual earnings from
piecework, weight or zone pay, and/or commission earnings received from
September 1, 2019 through August 31, 2020 are used for the 2021 annual open
enrollment. For newly eligible and employees with less than 12 months of earnings,
the Base Pay Rate will be projected.
• Base Plus Team Members – Annualized base hourly rate of pay (if hourly) or base
annual rate of pay (if salaried) plus earnings attributable to piecework, weight or
zone pay, and/or commission earnings received from September 1, 2019 through
August 31, 2020 are used for the 2021 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.
26
Pharmacy Benefits
Caremark’s network includes Coverage of Contraception for
CVS, Walgreens, Target, Walmart, Women under Health Care Reform
Longs, Rite Aid, Costco, Sam’s In accordance with the federal guidelines
Clubs, and most supermarkets and issued for Women’s Preventive Services as
independent pharmacies (as of the part of the Affordable Care Act, the plan
printing of this guide). Visit www.caremark. provides coverage of the full range of FDA-
com for a current list of participating approved contraceptive methods at NO cost
pharmacies, or call 1-844-431-4881. to the member for generics and approved
brand names. No-cost contraception is
Primary/Preferred Drug List available in both retail and mail order.
The prescription drug plan follows the Step Therapy Program
prescribing recommendations in the CVS
Caremark Primary/Preferred Drug List (CVS Certain classes of drugs require the
Drug List). This list is periodically updated member to first try a less expensive, but
by the CVS Caremark National Pharmacy therapeutically equivalent, preferred drug
and Therapeutics Committee. Drugs may before ‘stepping up’ to a more expensive
be removed from the CVS Drug List if they brand name drug. The drug classes
become offered as a generic, are available requiring participation in the step therapy
over-the-counter (OTC), are discontinued program can be found on the company
by the manufacturer, and/or have other cost intranet.
effective alternatives. The latest CVS Drug List To learn more about step therapy, visit the link
is available at www.caremark.com. in the QR code at the top of the page.
Generics First Line of Prescribing Maintenance Choice® for 90-day
This prescription drug plan automatically Supply of Maintenance Drugs
substitutes a generic for a brand name drug If you or a family member take a maintenance
when a generic equivalent is available. 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.
27 Dawn Johnson, Office Administator
27
Clearwater, FL
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 packaging Same-day prescription availability
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
Consumer Plan (HDHP) Standard PPO Plan
The Consumer Plan combines the deductible Annual Deductible under the Standard PPO
for both medical and prescription drug Plan
expenses. When you enroll in the Consumer You will pay the first $100 of the discounted cost
Plan, CVS Caremark will administer your for prescription drugs for each member of your
prescription drug coverage. Non-preventive family (limited to $200 for employee plus one
prescription drug expenses will apply toward dependent, and limited to $300 for Employee
your medical plan deductible and out-of- plus two or more dependents). The annual
pocket maximum deductible applies to non-maintenance generic
and brand-name drugs.
The Consumer Plan offers the same Preferred
Drug List or Formulary as the Standard Plan. Tiered Copays
When you fill a non-preventative prescription, Covered prescriptions have tiered copays.
you will pay the full discounted cost of the These tiers are broken out for:
medication until you have met your deductible.
Once you meet the deductible, you will pay 20 • Generic Drugs
percent of the medication through coinsurance • Brand Name Formulary (preferred brand
and the plan will pay 80 percent, until you have names)
met your out-of-pocket maximum. • Brand Name Non-Formulary (non-preferred
brand names)
Preventive Therapy Drug List • Specialty Prescriptions
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 by law,
such as women’s contraceptives.
Breanne Fetters, Sales Support Rep
28
Bend, OR 28
Medical Gap Insurance
Benefits Provided Dependent Eligibility
The Gap Plan is a fully insured product If your dependents are eligible for coverage
offered through Sun Life Financial. This plan in the BCBS Medical Plan sponsored by the
provides payment to you for out of pocket Company, they are eligible for enrollment in
expenses due to hospital confinements and the Gap Plan. Individuals in your family on
outpatient treatment for a covered injury or whom you expect to receive reimbursement
sickness up to the plan’s annual calendar under the Gap Plan must also be enrolled in
year limits. 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, 2021.
Premiums are withheld on a pre-tax basis.
*Enrollment in the Medical Gap Plan is
contingent on enrollment in one of the
company sponsored medical plans where you
Rachael Wilson, Design Sales Specialist are NOT also contributing to a Health Savings
Kodiak, AK Account (HSA).
Weekly Rates Bi-Weekly Rates
<40 40-49 50+ < 40 40-49 50+
Employee $8.21 $11.24 $18.37 $16.41 $22.47 $36.73
Employee + $14.78 $20.22 $33.05 $29.56 $40.44 $66.10
Spouse
Employee +
Child(ren) $18.20 $20.73 $29.81 $36.40 $41.46 $59.62
Employee + Family $24.77 $29.71 $44.48 $49.53 $59.41 $88.96
29
800-648-8624
www.slfserviceresources.com
MAX BENEFIT
WHAT IS COVERED
PER PERSON
In Patient Benefits • Hospital confinement due to a covered illness
Pays benefits up to or injury
the amount shown, per • Hospital emergency room treatment $4000
covered person, per
calendar year
Outpatient Benefits • Outpatient treatment due to a covered injury or
Subject to a per family/per sickness at a hospital $2000
calendar year maximum • Outpatient surgical or emergency facility or a not to exceed $4,000
of two individuals diagnostic testing facility or similar facility that per family per year
is licensed to provide outpatient treatment or two individuals
• This includes radiation and chemotherapy. covered in the year
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 abuse (even though
such expenses ARE covered by the BCBS $0
Medical Plans)
• Otherwise eligible expenses which are paid
by the Medical Plan at 100%; only expenses
applied to deductible and coinsurance are
reimbursable.
Diana Dacuma, Sales Support Representative 30
30
Longmont, CO
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 $0.56 $2.42 Employee Only $0.28 $1.21
Employee + Spouse $1.08 $4.61 Employee + Spouse $0.54 $2.31
Employee + Children $1.26 $5.39 Employee + Children $0.63 $2.69
Employee + Family $1.86 $7.97 Employee + Family $0.93 $3.98
31
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 over
Conventional $0 Copay, $105 allowance, plus balance
Disposable over$105
Medically Necessary $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 (in lieu of contact lenses) No limit (discount only) 1x every 12 months 2x every 12 months**
Contact Lens (in lieu of lenses) No limit (discount only) 1x every 12 months 1x every 12 months
Frames No limit (discount only) 1x every 12 months 1x 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. 32
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-pocket When you enroll for dental coverage,
costs, it is recommended that you or your dentist you will receive an ID card from
request a pre-treatment estimate for any services MetLife. Register for MyBenefits on
that may cost more than $300. This often applies MetLife’s website, www.metlife.com/
to services such as crowns, bridges, inlays and mybenefits. On this website, you can
periodontics. To get an estimate, have your dentist also find a provider, print an ID card,
submit a request online at www.metdental.com learn about plan benefits and check
or call 1-877-638-3379. You and your dentist will the status of a claim. You can also
receive a benefits estimate – for most procedures call MetLife’s Customer Service at
– while you’re still in the dentist’s office. 1-800-474-7371.
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 – fillings, You pay: Deductible + 30% You pay: Deductible + 20%
extractions
Major Type C Services – crowns, You pay: Deductible + 60% You pay: Deductible + 50%
implants, root canals, etc.
Annual Plan Limit per Covered $1,000 $2,000
Individual
Orthodontia (available to dependent Not covered You pay: 50% of allowable
children under age 26 only) charges up 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.
MetLife Smartphone App
You can: Search “MetLife” at iTunes App
; Find a dentist Store or Google Play to download
; Get estimates for most procedures the MetLife US Mobile App,
; View your plan summary
; View your claims
; Track your brushing and flossing
; View your ID card
33
To locate a provider near you,
call 1-800-474-7371 or go to
www.metlife.com/mybenefits
Bi-Weekly Payroll Deductions Weekly Payroll Deductions
Basic Enhanced Basic Enhanced
Dental Dental Dental Dental
Employee Only $10.06 $14.70 Employee Only $5.03 $7.35
Employee + Spouse $20.01 $29.40 Employee + Spouse $10.01 $14.70
Employee + Children $21.46 $26.52 Employee + Children $10.73 $13.26
Employee + Family $33.53 $44.86 Employee + Family $16.76 $22.43
Heather Tompkins, Design Tech
Savannah, GA
Did you know?
It is better for your teeth if you
floss before brushing!
34
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.
Employees who live or work in the states of California, New Jersey, New York and Washington
are enrolled automatically in the applicable state-mandated short-term disability and, where
applicable, paid family leave programs.
Benefits under the Voluntary Short Term Disability plan will be reduced by benefits paid
under any state Short Term Disability program in California, New Jersey, New York and
Washington (where such plans are required). Employees in these states should consider
whether the election of the Voluntary Short-Term Disability is beneficial.
Our voluntary Short-Term Disability 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 37)
70% of base wage—no 60% of base wage, limited to $10,000/month
Plan Pays limit
Benefit Payment On 15th day of disability On 91st day of disability
Starts
Maximum Benefit 11 weeks from benefit To Social Security Normal Retirement Age,
Period payment start depending on 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
Proof of Good Health Not required No, when first eligible; yes, as a 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, Washington, New Jersey, and New York (at the time of this publication)
may be impacted.
35
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
Your Base Weekly Pay
___________________ / 100 = ____________ x .42 = ______________
Weekly Premium
Per Paycheck
# of Pay Periods*
Then, __________________ x 52 / _________________ = _____________
Weekly Premium
*26 if paid Bi-Weekly or 52 if paid weekly
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
Frank Rolfes, General Manager Wendy Fletcher, Outside Sales Rep
Longmont, CO Houston, TX
Barry Burmaster, Dir. of Merchandising Teresa MacDonald, Office Administrator
Dallas, TX Point of Rocks, MD 36
Long Term Disability
The Long-Term Disability (LTD) Plan is a months. A pre-existing condition is a
fully-insured plan offered through Sun Life. sickness or injury for which you, during
Enrollment in the LTD plan is voluntary. the three months prior to your coverage
The plan is designed to provide income effective date, received medical treatment,
protection to you during times of extended consultation, care or services; took
illness or injury over several months or even prescription medication or had medications
years, depending on your age at the onset prescribed.
of disability. If you are receiving benefit
payments under the STD plan and become The plan imposes a 24-month benefit
eligible for LTD, your claim will automatically duration limit for certain illnesses such
transition to Sun Life’s LTD claims unit. LTD as mental/nervous conditions, chemical
payments will be paid to you directly by Sun dependency, chronic fatigue and
Life, beginning on the 91st day of disability. fibromyalgia.
You can see more ways to compare LTD and
STD on p. 31. Cost of Coverage
The Company shares the cost of LTD
Plan Benefit coverage with you. In the event of your
Benefits are payable for illness or injury disability, the portion of the benefit you
after 90 continuous days of disability with receive under the plan attributable to your
benefit payments to begin on your 91st day of share of the cost of coverage is not taxable
disability. The plan will pay 60 percent of your to you. The portion of your benefit payment
base rate of pay in effect prior to your date of attributable to the shared cost paid by the
disability up to a limit of $10,000 per month. Company is taxable to you.
Your monthly benefit under the plan will be
offset for other household income, such as Calculate your cost for Long-Term
social security or worker’s compensation Disability
earnings. Your premium is determined by your base
rate of pay. These premiums are withheld
Plan Limitations and Exclusions on an after-tax basis. When using Dayforce
The plan does not cover disability due to a enrollment, your cost for coverage will
pre-existing condition until you have been automatically populate. The formula used to
covered under the plan for 12 consecutive calculate your premium is below..
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
Monthly Premium
# of Pay Periods*
Then, __________________ x 12 / _________________ = _____________
*26 if paid Bi-Weekly or 52 if paid weekly
37
Enrollment Subsequent to Initial
Eligibility Angela Hubertus, Inside Sales Rep
Unlike the STD plan, if you do not enroll in San Antonio, TX
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
60 60 Months*
61 48 Months*
62 42 Months* How to Report a Disability Claim
Call Sun life at 833-812-5177. Please have this
63 36 Months* information handy:
64 30 Months* ; Your name, address, phone number, birth
date, date of hire, Social Security number
65 24 Months* ; Your employer’s name, address and
66 21 Months* phone number
67 18 Months* ; Date of your claim and when you plan to
68 15 Months* return to work
69+ 12 Months* ; If you’re pregnant, give your expected
delivery date
*or SSNRA, whichever is longer ; Name, address and phone number
of each doctor you are seeing for this
absence
38
Survivor Benefits
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 ; Your current legal spouse;
children. The premium cost for optional ; An unmarried child from live birth to age
coverage is paid by you through payroll 26 (meaning 25 years of age or younger);
deductions. Enrollment in Optional Life and ; An unmarried child age 26 and above
Voluntary AD&D are separate elections. who is financially dependent on you due
to a disability
Note: Evidence of Insurability (EOI)
may apply to Employee and The Company will not seek to verify you have
Spouse Optional Life. EOI enrolled an eligible dependent in these plans.
is never required for Vol. If you enroll an ineligible dependent for life
AD&D or Child Life. EOI insurance or AD&D, there will be no benefit
Guidelines can be viewed by payout in the event of a loss. Your dependents
clicking here or by scanning who are insured under these plans as an
the QR code. Employee of the Company may not also be
insured as a dependent.
Mark Whipple, Driver
Iowa Falls, IA
39
39
39
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)
(Maximum combined limit of $2 million for basic + optional life)
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 $25,000)
exceed Employee’s combined
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.
Employee/Spouse Rates Child Rate
Age Monthly Rate per Age Monthly Rate per
$1,000 of Coverage $1,000 of Coverage
<25 .04 0-26 .125
25-29 .05
30-34 .07 Here is an example of how the cost for employee
35-39 .09 optional life (or Spouse Life) is calculated for an
individual (Employee or Spouse), age 42 who
40-44 .10 elects $100,000 of coverage.
45-49 .15 To determine cost per paycheck:
50-54 .23 ($100,000/1,000) x .10 = $10.00 per month. Then
55-59 .37 ($10.00 x 12) = $120 total annual cost.
60-64 .66
65-69 1.27 Then, 120 divided by 26 for biweekly or 52 for
weekly = $4.62 per biweekly paycheck or $2.31
70+ 2.06 per weekly check.
Voluntary AD&D – Employee, Spouse & Child
The same rate applies to anyone enrolled in these plans: .025 per $1,000 of coverage.
1. Enter number of units of coverage _____
2. Enter Rate .025
3. Multiply Line 1 X Line 2 _____
4. Multiply Line 2 times 12 _____
5. Divide Line 4 by 26 for bi-weekly or 52 for weekly rate.
This is the amount withheld from your paycheck - _____
*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. 40
Health FSA & LPFSA
What are they, and should I consider enrolling? Enrollment in these accounts
The Company offers two types of accounts that may reimburse you is never automatic. It is
for your eligible out-of-pocket expenses; a Health Care Flexible mandatory that you actively
Spending Account (FSA) and a Limited Purpose Flexible Spending enroll in your FSA each year
Account (LPFSA). during Open Enrollment or
your new hire enrollment.
Health FSA LPFSA (Limited Purpose FSA)
Standard PPO Consumer HDHP with HSA
Which medical Consumer HDHP (No HSA)
plan is this account You don’t need to be enrolled in
available for? a medical plan to contribute to a
Health FSA.
Eligible healthcare expenses, This health care account is only
What would I use this including dental, vision and available if you are contributing
prescription medication expenses. to an HSA and you can only use
account for? it for eligible vision and dental
expenses.
What is the $2,750 - the IRS pre-tax $2,750 - the IRS pre-tax
maximum amount I contribution limit as of this writing contribution limit
can contribute to this as of this writing
account?
Your entire goal amount is Your entire goal amount is
When are the funds available at the beginning of the available at the beginning of the
available? benefit period. benefit period.
You will forfeit amounts not You will forfeit amounts not
What happens if I claimed for expenses incurred claimed for expenses incurred
don’t use the money during the benefit period. during the benefit period.
during the year?
Contribution allowed Yes Yes, to end of year in which
for Medicare Medicare enrollment first occurs
enrolled?
WageWorks - 1-877-924-3967 WageWorks - 1-877-924-3967
Provider Contact
How to File FSA Claims
File claims with WageWorks (now Health Equity.) File claims with HealthEquity
through March 31, 2022 for 2021 FSA expenses incurred through December
31, 2021. Log on to https://www.wageworks.com/paymentoptions/ or use the
WageWorks EZ Receipts mobile app, available in the App Store and Google Play.
To learn more visit www.wageworks.com/myfsa.
There is also an online chat option on the website and the app.
41
Dependent Care FSA
The Dependent Daycare FSA offers a Forfeiture of Benefits
convenient way to use pre-tax dollars to pay Be conservative in estimating health and
for eligible child and elder care expenses dependent care expenses. You will forfeit
(generally expenses you incur so that you can amounts remaining in your Health Care and/
work). Enrollment is not automatic. You must or Dependent Care FSA account(s) for which
actively enroll in the Dependent Care FSA you are unable to claim reimbursable expenses.
each year. Funds DO NOT roll over from year-to-year.
Unlike an HSA, you must use the funds in your
Contributions are deducted from each FSA by December 31, 2021, or you lose them.
paycheck and deposited into an account that Deadline for claims submission: All claims for
may be accessed with a claim form. reimbursement for the 2021 plan year must be
filed with WageWorks prior to March 31, 2022.
The Dependent Daycare FSA has IRS Expenses You Can Pay with a
limitations of $5,000 per year and further Dependent Daycare FSA:
limitations for certain married participants. Child Care (while you work) for child(ren) under
Your taxable income will be reduced by the age 13, provided by
amount you set aside for your FSA every pay ; After school program
period. It is important to estimate the amount ; Daycare center
of your out-of-pocket expenses carefully and ; An individual who is NOT also your tax
plan your payroll contributions accordingly. dependent
; Summer day camp
Unlike Health FSA, the Dependent Care FSA
can only reimburse you for amounts you have Elder Care (of your tax dependent)
on deposit as you incur claims. You must ; In your home
incur reimbursable Dependent Care expenses ; Adult daycare
during the 2021 plan year or during your
benefit period if enrolling as a newly eligible NOT REIMBURSABLE:
employee. 4 Health care expenses of your child or other
dependent
Before you enroll in Dependent Day- 4 Babysitting for non-work related activities
care FSA, note this account is NOT 4 Dance lessons
for reimbursement of dependent 4 Tutoring services
health care expenses! 4 Field trips
Do not enroll in this plan unless you expect 4 Dog walking
to incur eligible expenses, such as daycare
services that can be substantiated with a
receipt.
Also consider: Compare the Dependent
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.
Dave Rush, COO-East 42
Charlotte, NC 42
Health Saving Account (HSA)
If you are looking for ways to boost your savings As a first time participant, you must
and plan for retirement medical expenses, consider contact Fidelity to open your Health
enrolling in our BCBS Consumer High Deductible Savings Account.
Health Plan to take advantage of the Fidelity Health
Savings Account (HSA). You can benefit from - Log on to Fidelity via netbenefits.com,
; Triple tax savings – your contributions, any choose the Health Savings Account
earnings, and withdrawals are tax free* when tile and click “open your account.”
used to pay for qualified medical expenses.
; Any unused money in your HSA carries over After your Health Savings Account
each year and is yours to keep, even if you is established, you may request a
change employers. Fidelity HSA Debit Card (checks are
; You have the opportunity to invest your available upon request).
contributions, giving them the potential to grow
for future use, including retirement.
$3,600 Employee Only Coverage
What is the maximum $7,200 Family Coverage
amount I can contribute If you’ll be at least 55 years old in 2021, you can make an
to this account? additional $1,000 catch up contribution.
All deductions are taken on a pre-tax basis.
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 don’t All unused funds will remain in your HSA. You can take HSA
use the money during funds with you when you leave the company or retire.
the year?
Fidelity - www.netbenefits.com or
To Enroll 800-544-3716
Alli Quezada,Human Resources Assistant NOTE: Be aware that the IRS prohibits you from
North Texas Door making contributions to an HSA while enrolled in
Medicare or a Medicare Advantage plan,
or an FSA. 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
plan, and it is not an ERISA plan.
43 43
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 contributions
have completed 60 days of employment. you make to your account. You become vested
in employer matching contributions on the
When Does Participation Begin? following schedule:
Employees hired or rehired on or after 1/1/2020
are automatically enrolled at a contribution Years of Service Percent Vested
rate of 1%. Less than 1 0%
Your Contributions One year 20%
You may contribute up to 75% of your eligible Two years 40%
earnings on a pre-tax basis to the 401(k) plan,
up to the annual IRS limit ($19,500 as of this Three years 60%
writing). If you are age 50 or greater, you Four years 80%
may be eligible for an additional “catch-up”
contribution ($6,500 as of this writing). You Five or more years 100%
specify the percentage of your earnings you
want to contribute. You can change how much Receiving Money From Your Account
you are contributing at any time. Contact The plan is intended to accumulate funds for
Fidelity Investments directly to start, change or your retirement. However, you may have access
stop your contribution. to your funds while you are still employed by the
company under the following circumstances:
Company Match ; You are age 59-1/2 or greater
In addition to your pre-tax contributions, ; You become disabled (as determined by the
Builders FirstSource helps you save by making Social Security Administration)
the following matching contribution: ; You experience a financial hardship, as
40% of your pre-tax contributions up to 5% defined by the IRS Code
of your eligible compensation ; You take a loan against your 401(k) account,
as allowed under the plan document
The company does not contribute a match on
catch-up contributions. New Roth feature in 2021! In 2021, employees
may elect to treat all or a portion of your 401(k)
Investing Your Account contributions as pre-tax or after-tax under the
You direct how your account is invested. You new Roth contribution feature. Unlike traditional
choose from a variety of funds offered through pre-tax 401(k) contributions, Roth 401(k)
Fidelity, including “target date” funds to align contributions are designed to allow for tax-free
with your estimated retirement date. income in retirement with contributions made
Don’t forget to add a using after-tax dollars now. The same employer
matching contribution will apply to your Roth
beneficiary! contributions. More details will be provided near
year-end 2020.
Zach Straits, General Manager 44 44
Verona, VA
Picture Gallery
Harold Berrios Bob Murnigham Carrie Brown
Driver - CDL Boom/Crane Sales Product Manager Office Administrator
Charlotte, NC Boise, ID Clackamas, OR
Natasha Schachle Eric Sebring Maria Hamershock
Inside Sales Rep General Manager Pricing & Margin Administrator
Wasilla, AK Blairsville, GA Gypsum, SC
Tricia Kirby Yvonne Martinez Caye Moberg
Manager Office Admin Leave of Absence Admin Pricing & Margin Admin
Traverse City, MI Dallas, TX Admin Center, NW
45
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!
Tisha Moreno Ryan Brech Chris Conoley
Office Administrator Manager Operations Inside Sales Rep
Manvel, TX Sioux Falls, SD Asheville, NC
Breanne Fetters Jennifer Hansen Jenelle Cline
Sales Support Rep Office Administrator Manager Accounting
Bend, OR Sioux City, IA Dallas, TX
Cynthia Abujen Marissa Lomax Laree Ericsson
Office Administrator Fund Control Processor Credit Analyst
South Bay, CA Fund Control Data Input Denver, CO
General Administrative
46
Required Notices
Important Notice from Builders FirstSource first, and Medicare will determine its payments
(BFS) and About Your Prescription Drug Cover- second. For more information about this issue of
age and Medicare what program pays first and what program pays
Please read this notice carefully and keep it where second, see the Plan’s summary plan description or
you can find it. This notice has information about contact Medicare at the telephone number or web
your current prescription drug coverage with address listed herein.
Builders FirstSource (BFS) and about your options
under Medicare’s prescription drug coverage. This If you do decide to join a Medicare drug plan and
information can help you decide whether or not drop your current Company-sponsored medical
you want to join a Medicare drug plan. If you are coverage, be aware that you and your dependents
considering joining, you should compare your current will not be able to get this coverage back.
coverage, including which drugs are covered at what
cost, with the coverage and costs of the plans offering When Will You Pay A Higher Premium (Penalty) To
Medicare prescription drug coverage in your area. Join A Medicare Drug Plan?
Information about where you can get help to make You should also know that if you drop or lose your
decisions about your prescription drug coverage is at current Company-sponsored medical coverage and
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 higher
set by Medicare. Some plans may also offer more premium (a penalty) as long as you have Medicare
coverage for a higher monthly premium. prescription drug coverage. In addition, you may have
2. Builders FirstSource (BFS) has determined that to wait until the following October to join.
the prescription drug coverage offered under
the Company-sponsored medical plan(s) is, on For More Information about This Notice or Your
average for all plan participants, expected to pay Current Prescription Drug Coverage
out as much as standard Medicare prescription Contact the persons listed at the end of these
drug coverage pays and is therefore considered notices for further information. NOTE: You’ll get this
Creditable Coverage. Because your existing notice each year. You will also get it before the next
coverage is Creditable Coverage, you can keep this period you can join a Medicare drug plan, and if the
coverage and not pay a higher premium (a penalty) Company-sponsored medical coverage changes. You
if you later decide to join a Medicare drug plan. also may request a copy of this notice at any time.
When Can You Join A Medicare Drug Plan? For More Information about Your Options under
You can join a Medicare drug plan when you first Medicare Prescription Drug Coverage
become eligible for Medicare during a seven-month More detailed information about Medicare plans that
initial enrollment period. That period begins three offer prescription drug coverage is in the “Medicare
months prior to your 65th birthday, includes the month & You” handbook. You’ll get a copy of the handbook
you turn 65, and continues for the ensuing three in the mail every year from Medicare. You may also
months. You may also enroll each year from October be contacted directly by Medicare drug plans. For
15th through December 7th. However, if you lose your more information about Medicare prescription drug
current creditable prescription drug coverage, through coverage:
no fault of your own, you will also be eligible for a two • Visit www.medicare.gov
(2) month Special Enrollment Period (SEP) to join a • Call your State Health Insurance Assistance
Medicare drug plan. Program (see the inside back cover of your copy of
the “Medicare & You” handbook for their telephone
What Happens To Your Current Coverage If You number) for personalized help
Decide to Join A Medicare Drug Plan? • Call 1-800-MEDICARE (1-800-633-4227). TTY
If you decide to join a Medicare drug plan, your current users should call 1-877-486-2048
coverage in the Company-sponsored medical plan(s) If you have limited income and resources, extra help
will not be affected. For most persons covered under paying for Medicare prescription drug coverage is
the Plan, the Plan will pay prescription drug benefits available. For information about this extra help, visit
Social Security on the web at www.socialsecurity.gov,
or call them at 1-800-772-1213 (TTY 1-800-325-0778).
47
Remember: Keep this Medicare Part D notice. HIPAA Special Enrollment Rights
If you decide to join one of the Medicare drug If you are declining enrollment for yourself or your
plans, you may be required to provide a copy of dependents (including your spouse) because
this notice when you join to show whether or not of other health insurance or group health plan
you have maintained creditable coverage and, coverage, you may be able to later enroll yourself
therefore, whether or not you are required to pay and your dependents in this plan if you or your
a higher premium (a penalty). dependents lose eligibility for that other coverage
(or if the employer stops contributing towards your
Date: October 1, 2020 or your dependents’ other coverage).
• Loss of eligibility includes but is not limited to:
Contact Information • Loss of eligibility for coverage as a result
Name of Entity/Sender: Builders FirstSource(BFS) of ceasing to meet the plan’s eligibility
Contact—Position/Office: Employee Benefit Dept requirements (i.e. legal separation, divorce,
Address: 2001 Bryan Street, Suite 1600 Dallas, TX cessation of dependent status, death of
75201 an employee, termination of employment,
Phone Number: 1-844-216-9320 reduction in the number of hours of
employment);
Women’s Health and Cancer Rights Act • Loss of HMO coverage because the person
The Women’s Health and Cancer Rights Act of 1998 no longer resides or works in the HMO service
was signed into law on October 21, 1998. The Act area and no other coverage option is available
requires that all group health plans providingmedical through the HMO plan sponsor;
and surgical benefits with respect to a mastectomy • Elimination of the coverage option a person
must provide coverage for all of the following: was enrolled in, and another option is not
• Reconstruction of the breast on which a offered in its place;
mastectomy has been performed • Failing to return from an FMLA leave of
• Surgery and reconstruction of the other breast to absence; and
produce a symmetrical appearance • Loss of coverage under Medicaid or the
• Prostheses Children’s Health Insurance Program (CHIP).
• Treatment of physical complications of all stages of Unless the event giving rise to your special
mastectomy, including lymphedema enrollment right is a loss of coverage under
This coverage will be provided in consultation Medicaid or CHIP, you must request enrollment
with the attending physician and the patient, and within 31 days after your or your dependent’s(s’)
will be subject to the same annual deductibles other coverage ends (or after the employer that
and coinsurance provisions which apply for the sponsors that coverage stops contributing toward
mastectomy. For deductibles and coinsurance the coverage).
information applicable to the plan in which you enroll,
please refer to the summary plan description or If the event giving rise to your special enrollment
contact Human Resources at 1-844-216-9320. right is a loss of coverage under Medicaid or
the CHIP, you may request enrollment under
HIPAA Privacy and Security this plan within 60 days of the date you or your
The Health Insurance Portability and Accountability dependent(s) lose such coverage under Medicaid
Act of 1996 deals with how an employer can enforce or CHIP. Similarly, if you or your dependent(s)
eligibility and enrollment for health care benefits, as become eligible for a state-granted premium
well as ensuring that protected health information subsidy towards this plan, you may request
which identifies you is kept private. You have the right enrollment under this plan within 60 days after the
to inspect and copy protected health information date Medicaid or CHIP determine that you or the
that is maintained by and for the plan for enrollment, dependent(s) qualify for the subsidy.
payment, claims and case management. If you
feel that protected health information about you is In addition, if you have a new dependent as a
incorrect or incomplete, you may ask your benefits result of marriage, birth, adoption, or placement
administrator to amend the information. for adoption, you may be able to enroll yourself
and your dependents. However, you must request
The Notice of Privacy Practices has been recently enrollment within 31 days after the marriage, birth,
updated. adoption, or placement for adoption.
For a full copy of the Notice of Privacy Practices, To request special enrollment or obtain more
describing how protected health information about information, contact Human Resources at
you may be used and disclosed and how you can get 1-844-216-9320.
access to the information, contact Human Resources
at 1-844-216-9320.
48
Notice of Health Insurance
Marketplace Coverage Options
(as Required by the Affordable Care Act) excluded from income for federal and state income
Why am I receiving this Notice? tax purposes. Your payments for coverage through the
Key parts of the Affordable Care Act became effective Marketplace are made on an after-tax basis.
in 2014, including the launch of the Health Insurance
Marketplace (the “Marketplace”). The Marketplace Information about health coverage available through
provides a new way to buy health insurance, separate Builders FirstSource
from health coverage that may be offered to you If you decide to complete an application for coverage
through your employment with Builders FirstSource in the Marketplace, you will be asked to provide this
and its family of companies. The purpose of this notice information. The information provided below is numbered
is to provide you some basic information regarding to correspond to the Marketplace application.
the Marketplace. Detailed information regarding the
Marketplace is available at Healthcare.gov. 3. Employer Name* 4. Employer
(BFS Company Description) Identification
What is the Health Insurance Marketplace? Number (EIN)
The Marketplace is designed to help you find health Builders FirstSource – Dallas (Corporate) 75-2794867
insurance that may meet your needs and fit into your
budget. The Marketplace is designed to offer “one-stop Builders FirstSource – Atlantic 52-2080519
shopping” to find and compare private health insurance
options. Open enrollment for health insurance coverage Builders FirstSource – Florida 52-2172981
through the Marketplace begins on November 1, 2020
and ends December 15, 2020 for coverage starting on Builders FirstSource – Raleigh 56-1454419
January 1, 2021. The Marketplace is separate from health Builders FirstSource – Southeast 57-0618425
coverage that may be available to you through Builders
FirstSource. Builders FirstSource – South Texas 75-2916346
The Marketplace can help you evaluate your coverage Builders FirstSource – Arlington/Lewisville/ 75-2831224
options, including your eligibility for coverage through Jarrell/Sherman
the Marketplace and its cost. Visit Healthcare.gov for
more information, including an online application for Builders FirstSource–Texas Installed 75-2896780
coverage or call 1-800-318-2596. Sales, LP
Can I save money on my health insurance premiums ProBuild LLC 20-4011397
in the Marketplace? ProBuild (Spenards Builders Supply Inc) 92-0018778
You may qualify to save money and lower your monthly
premium, but only if Builders FirstSource does not offer ProBuild (Dixieline Fund Control Inc) 57-1168729
coverage, or offers coverage that doesn’t meet certain
standards. The savings on your premium that you’re *If you are unsure which Builders FirstSource company you work for,
eligible for depends on your household income. please refer to your paycheck or contact Human Resources.
Does employer health coverage affect eligibility for 5.Employer Address: Builders FirstSource, 2001 Bryan St,
premium savings through the Marketplace? Ste 1600
Yes. If you have an offer of health coverage from Builders
FirstSource that meets certain standards, you will not 6.Employer phone number: 1-844-216-9320
be eligible for a tax credit through the Marketplace 7.City: Dallas 8.State: Texas 9.Zip code: 75201
and may wish to enroll in coverage through Builders
FirstSource. However, you may be eligible for a tax 10.Who can we contact about employee health coverage at
credit that lowers your monthly premium, or a reduction this job?
in certain cost-sharing if Builders FirstSource does not Corporate Benefits Department
offer coverage to you at all or does not offer coverage 11. Phone number: 1-844-216-9320
that meets certain standards. If the cost of a plan from 12. Email address: [email protected]
Builders 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 week
does not meet the “minimum value” standard set by the after a 60-day waiting period.
Affordable Care Act, you may be eligible for a tax credit. • With respect to dependents, we offer coverage to verifiable
Note: If you purchase a health plan through the spouses and children of eligible employees.
Marketplace instead of accepting health coverage • The cost of the employee’s coverage is intended to be
offered by your employer, then you will lose the employer affordable, based on employee earnings.**
contribution to the employer-offered coverage. Also,
this employer contribution – as well as your employee 14.Does Builders FirstSource offer a health plan that meets
contribution to employer-offered coverage – is often minimum value standards? Yes
49
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