2021 Team Member Benefit Guide - English

Premium Assistance Under

Medicaid & CHIP




If you or your children are eligible for Medicaid how to apply. If you qualify, ask your state if
or CHIP and you’re eligible for health coverage it has a program that might help you pay the
from your employer, your state may have a premiums for an employer-sponsored plan.
premium assistance program that can help pay
for coverage, using funds from their Medicaid If you or your dependents are eligible for
or CHIP programs. If you or your children aren’t premium assistance under Medicaid or CHIP,
eligible for Medicaid or CHIP, you won’t be as well as eligible under your employer plan,
eligible for these premium assistance programs your employer must allow you to enroll in
but you may be able to buy individual insurance your employer plan if you aren’t already
coverage through the Health Insurance enrolled. This is called a “special enrollment”
Marketplace. For more information, visit www. opportunity, and you must request coverage
healthcare.gov. within 60 days of being determined
eligible for premium assistance. If you have
If you or your dependents are already enrolled questions about enrolling in your employer
in Medicaid or CHIP and you live in a State plan, contact the Department of Labor at
listed below, contact your State Medicaid or www.askebsa.dol.gov or call 1-866-444-EBSA
CHIP office to find out if premium assistance is (3272).
available.
If you live in one of the following states,
If you or your dependents are NOT currently you may be eligible for assistance paying
enrolled in Medicaid or CHIP, and you think you your employer health plan premiums.
or any of your dependents might be eligible for The following list of states is current as of
either of these programs, contact your State July 31, 2020. Contact your State for more
Medicaid or CHIP office or dial 1-877-KIDS information on eligibility.
NOW or www.insurekidsnow.gov to find out


State Website Contact
Alabama - Medicaid http://myalhipp.com/ 1-855-692-5447
Alaska - Medicaid The AK Health Insurance Premium Payment 1-866-251-4861
Program http://myakhipp.com/ Email:
Medicaid Eligibility: http://dhss.alaska.gov/ CustomerService@
dpa/Pages/medicaid/default.aspx MyAKHIPP.com
Arkansas - Medicaid http://myarhipp.com/ 1-855-MyARHIPP (855-
692-7447)
Colorado – Health Health First Colorado Health First Colorado
First Colorado (CO https://www.healthfirstcolorado.com/ Member Contact Center:
Medicaid Program) CHP+: 1-800-221-3943/ State
& Child Health Plan Colorado.gov/HCPF/Child-Health-Plan-Plus Relay 711
Plus (CHP+) CHP+ Customer Service:
1-800-359-1991/State
Relay 711
Florida - Medicaid http://flmedicaidtplrecovery.com/hipp/ 1-877-357-3268




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Premium Assistance Under

Medicaid & CHIP





Georgia - Medicaid Website: https://medicaid.georgia.gov/ 687-564-1162 ext
health-insurance-premium-payment-pro- 2131
gram-hipp
Indiana - Medicaid Healthy Indiana Plan for low-income adults Healthy Indiana -
19-64: http://www.in.gov/fssa/hip/ 1-877-438-4479
All other Medicaid: http://www.indianamed- All Other Medicaid -
icaid.com Phone 1-800-403-0864
Iowa - Medicaid http://dhs.iowa.gov/hawk-i 1-800-257-8563
Kansas - Medicaid http://www.kdheks.gov/hcf/ 1-785-296-3512
Kentucky - Medicaid https://chfs.ky.gov 1-800-635-2570
Louisiana - Medicaid http://dhh.louisiana.gov/index.cfm/sub- 1-888-695-2447
home/1/n/331
Maine - Medicaid http://www.maine.gov/dhhs/ofi/public-assis- 1-800-442-6003
tance/index.html TTY: Maine relay 711
Massachusetts - http://www.mass.gov/eohhs/gov/depart- 1-800-862-4840
Medicaid and CHIP ments/masshealth/
Minnesota - Medicaid https://mn.gov/dhs/people-we-serve/seniors/ 1-800-657-3739
health-care/health-care-programs/pro-
grams-and-services/other-insurance.jsp
Missouri - Medicaid http://www.dss.mo.gov/mhd/participants/pag- 573-751-2005
es/hipp.htm
Montana - Medicaid http://dphhs.mt.gov/MontanaHealthcarePro- 1-800-694-3084
grams/HIPP
Nebraska - Medicaid http://www.ACCESSNebraska.ne.gov (855) 632-7633
Lincoln: (402) 473-7000
Omaha: (402) 595-1178
Nevada - Medicaid Medicaid http://dhcfp.nv.gov Medicaid: 1-800-992-
0900
New Hampshire - https://www.dhhs.nh.gov/oii/hipp.htm 603-271-5218
Medicaid Toll free number for the
HIPP program: 1-800-
852-3345, ext 5218
New Jersey - Medicaid http://www.state.nj.us/humanser- Medicaid 609-631-
Medicaid and CHIP vices/dmahs/clients/medicaid/ 2392
CHIP http://www.njfamilycare.org/index. CHIP 1-800-701-0710
html
New York - Medicaid https://www.health.ny.gov/health_care/ 1-800-541-2831
medicaid/
North Carolina - https://medicaid.ncdhhs.gov/ 919-855-4100
Medicaid



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North Dakota - http://www.nd.gov/dhs/services/medicals- 1-844-854-4825
Medicaid erv/medicaid/
Oklahoma - Medicaid http://www.insureoklahoma.org 1-888-365-3742
and CHIP
Oregon - Medicaid http://healthcare.oregon.gov/Pages/index. 1-800-699-9075
aspx
http://www.oregonhealthcare.gov/index-es.
html
Pennsylvania - http://www.dhs.pa.gov/provider/medicalas- 1-800-692-7462
Medicaid sistance/healthinsurancepremiumpaymen-
thippprogram/index.htm
Rhode Island - http://www.eohhs.ri.gov/ Phone: 855-697-4347,
Medicaid and CHIP or 401-462-0311 (Di-
rect RIte Share Line)
South Carolina - https://www.scdhhs.gov 1-888-549-0820
Medicaid
South Dakota - http://dss.sd.gov 1-888-828-0059
Medicaid
Texas - Medicaid http://gethipptexas.com/ 1-800-440-0493
Utah - Medicaid and Medicaid https://medicaid.utah.gov/ 1-877-543-7669
CHIP CHIP http://health.utah.gov/chip
Vermont - Medicaid http://www.greenmountaincare.org/ 1-800-250-8427
Virginia - Medicaid Medicaid http://www.coverva.org/pro- Medicaid 1-800-432-
and CHIP grams_premium_assistance.cfm 5924
CHIP http://www.coverva.org/programs_ CHIP 1-855-242-8282
premium_assistance.cfm
Washington - http://www.hca.wa.gov/ 1-800-562-3022 ext.
Medicaid 15473
West Virginia - http://mywvhipp.com/ Toll-free 1-855-My-
Medicaid WVHIPP (1-855-699-
8447)
Wisconsin - Medicaid https://www.dhs.wisconsin.gov/publications/ 1-800-362-3002
and CHIP p1/p10095.pdf
Wyoming - Medicaid https://wyequalitycare.acs-inc.com/ 307-777-7531












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Contact Guide






Fidelity 401(k) 1-800-835-5095 www.netbenefits.com
Fidelity

Sun Life Financial - Gap 1-800-648- www.slfserviceresources.com
Policy 8624 Claims email:
Claims Address: Claims Fax: [email protected]
Fidelity Security Life Ins Co 1-816-968-0575
3130 Broadway,
P.O. Box 418131
Kansas City, MO 64141
Blue Cross Blue Shield of 800-521-2227 www.bcbstx.com
Texas
Claims Address: Check your ID card for group
P.O. Box 660044 and member ID number.
Dallas, TX 75266-0044
MDLive 888-680-8646
24/7 Nurseline 800-581-0368
Special Beginnings 888-421-7781
Fitness Program 888-762-2583
Provider Finder 800-810-2583
BVA # on back of ID
Member Rewards # on back of ID
Naturally Slim www.naturallyslim.com/bfs
[email protected]


CVS/Caremark Rx Standard 1-844-431-4881 www.caremark.com
Mail Order Claims Address:
P.O. Box 94467 Check your ID card for group
Palatine, IL 60094-4467 and member ID number.
RX Reimbursement Claims
Address:
P.O. Box 52136
Phoenix, AZ 85072-2136
Sun Life Disability & Leaves 1-833-812-5177
of Absence
EyeMed Vision 1-866-939-3633 www.eyemed.com
Claims Address: To find providers:
ATTN: OON Claims www.enrollwitheyemed.com/
P.O. Box 8504, access
Mason, OH 45040-7111 Check your ID card for group
Network: Access and member ID number.





53

Not sure who to call? Have a question about something not on this list? You can reach the
Benefits Team at [email protected] or 1-844-216-9320 for answers and assistance.




Guidance Resources 1-888-327-7401 www.guidanceresources.com
Employee
Assistance Plan
Org. Web ID: “BFSEAP”
MetLife Dental 1-800-474-7371 To find your group number and
Dental estimates 1-877-638-3379 search for providers:
Claims Address: www.metlife.com/mybenefits
P.O. Box 981282 Website for dentist use for pre-
El Paso, TX 79998 treatment estimates:
www.metdental.com

Fidelity Health Savings 1-800-544-3716 netbenefits.com or
Account (HSA) 401k.com

Quit for Life (Tobacco 1-866-784-8454 www.quitnow.net
Cessation)


SunLife Financial Life & 1-800-247-6875 www.sunlife.com/us
AD&D Insurance
Claims Address: PO BOX
81365
Wellesley Hills, MA 02481
WageWorks / Health Equity 1-877-924-3967 www.wageworks.com
Flexible Spending Account
Dependent Daycare Account
Limited Purpose FSA
Virta - for Type 2 Diabetes virtahealth.com/bfs





Hinge Health www.hinghealth.com/bfs



You must notify the Benefits Department within 31 days of a family status
change and provide the proper documentation to add or drop coverage.
These include marriage, divorce, birth, adoption, loss or gain of other
coverage due to dependent’s job status change or annual enrollment.
This guide provides highlights of your benefits. If any statement in this guide conflicts with any
applicable plan documents, the plan documents will govern. Plan provisions may be changed or
deleted in order to meet any state or legal requirements. The Company retains the right to amend
or terminate benefits as it deems necessary at any time. Benefit options, eligibility and other
details may be different for employees covered under a Collective Bargaining Agreement (CBA).
Refer to your CBA for specifics. This guide describes benefits for full time employees and does
not describe benefits eligibility for part time, seasonal or leased employees.
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Benefits Department 2001 Bryan Street, Suite 1600 Dallas, TX 75201 Open Enrollment is November 9-20, 2020 for 2021 Benefits!